Abstract
Introduction: Localized studies have reported a decline in myocardial infarctions during the coronavirus disease 2019 (COVID-19) pandemic. The mechanisms underlying these observations remain unknown, but evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened concern that true rates of myocardial infarctions have been under-ascertained and left untreated. Methods: We analyzed data from the National Emergency Medical Services Information System (NEMSIS) and incident COVID-19 infections across the United States between January 1, 2020 to April 30, 2020. Grouping events by US Census Division, multivariable adjusted negative binomial regression models were utilized to estimate the relationship between COVID-19 and EMS activations for chest pain, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), cardiac arrests, and ventricular arrhythmias. Results: After multivariable adjustment, increasing rates of COVID-19 were associated with a reduction in EMS activations for chest pain (RR 0.67, 95% CI 0.63-0.70, p < 0.001) and NSTEMIs (RR 0.16, 95% CI, 0.10-0.26; p < 0.001). Simultaneously, increasing COVID-19 was associated with a significant increase in EMS activations for cardiac arrests (RR 1.51, 95% CI 1.36-1.68, p < 0.001), ventricular fibrillation (RR 1.47, 95% CI 1.23-1.77, p < 0.001), and ventricular tachycardia (VT) episodes (RR 1.34, 95% CI 1.16-1.56, p < 0.001). These statistically significant relationships were consistently observed within each of the 9 US Census Divisions alone. Conclusions: Taken together, these data suggest that individuals are commonly delaying or avoiding care for myocardial infarction in areas with more COVID-19, leading to lethal consequences. Interventions aimed at reinforcing the need to seek appropriate care for suspected myocardial infarctions, even in the context of heightened infectious disease risks, should be pursued.
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