Abstract 16654: Covid - 19 - Acute Myocardial Infarction and Heart Failure Mortality Trends in a Non-epicenter Region

Abstract

Introduction: As the novel coronavirus gained acceleration, there are several reports of a decreasing number of hospital admissions for acute myocardial infarctions (AMI) worldwide. It is unclear if this is due to an actual decrease in their incidence or due to patients avoiding hospital visits during the pandemic. We examined the trends in admissions for AMI, acute decompensated heart failure (HF) and their associated mortality in an integrated health system (7 hospitals) in Pittsburgh (Pennsylvania), a non-epicenter region. Hypothesis: If patients are presenting late due to avoiding hospitals, AMI and HF would be associated with increased mortality rates. Methods: We collected data on the total number of admissions and deaths related to AMI (ST and non-ST elevation), HF using ICD-10 codes, during the period of January-April 2020. We compared this with data from the same period in 2018, 2019. Mortality rate was calculated as deaths per 100 admissions. Results: There were 505 AMI admissions in January-April 2020 and 37 died compared to 23 deaths amongst 645 admissions in the same period of 2018 and 2019 (averaged). Similarly, there were 1030 HF admissions in January-April 2020 and 46 died in comparison to 39 deaths amongst 1280 admissions in 2018 and 2019 (averaged). The absolute number of AMI and HF admissions was lower in 2020 (p<0.05, p<0.01). There was no difference in absolute number of deaths attributed to HF or AMI between 2020 and the preceding years (p=0.3). However, mortality rate was higher for HF in 2020 compared to prior 2 years. Conclusions: In this non-epicenter region, there was a significant decrease in admissions for AMI and HF in 2020 compared to 2018-2019 while the absolute number of deaths were similar. Similar mortality rates for AMI across the years suggests that patients were presenting appropriately and that the true incidence was likely low. However, higher mortality rate with HF may suggest a delayed presentation albeit without accounting for confounders.