Abstract 330: Effect Of Covid-19 Mitigation On Resource Utilization And Rates Of Acute Myocardial Infarction In Areas Of Higher And Lower Socioeconomic Vulnerability

Abstract

Background: Multiple reports demonstrate decreased emergency department (ED) utilization for cardiovascular emergencies during COVID-19. It is possible this decrease had downstream effects on the later severity of cardiovascular disease, especially in patients with higher social vulnerability. The purpose of this study was to determine the effect of early COVID-19 mitigation strategies on hospital resource utilization and acute myocardial infarction (AMI) admissions by social vulnerability. Methods: We retrospectively analyzed patients transported by emergency medical services (EMS) with a diagnosis of chest pain and/or AMI from a large urban Midwest EMS and single hospital system from Jan 1-Dec 31, 2020. Hospital office, telehealth, ED visits for chest pain, and hospital admissions for AMI were identified using the electronic health record. The 3 phases of COVID-19 mitigation were compared (pre-mitigation-Jan 1 st to Feb 28 th , mitigation-March 1 st to April 30 th , and post-mitigation-May 1 st -December 31 st ). The socioeconomic status theme of the Social Vulnerability Index (SVI) was determined. The primary outcome was rate of AMI per ED chest pain visit, which was compared between the highest and lowest SVI quartiles. Statistical comparisons were made using binary logistic regression and Chi-squared tests. Results: Overall, there was a similar increase in telehealth visits and a decrease in office visits during mitigation in both highest and lowest SVI quartiles. In the post-mitigation phase, patients with the highest social vulnerability had a 30% relative increase rate of AMI per ED chest pain visit (7.3% vs 5.5%, p=0.048) compared to patients with lower social vulnerability. This increase was not seen in the pre-mitigation (5.8% vs 6.1%) or mitigation (4.9% vs 5.4%, each p=ns) phases. Conclusions: After initial COVID-19 mitigation strategies were implemented patients with higher socioeconomic vulnerability presented to the ED with AMI at a higher rate than patients with a lower socioeconomic vulnerability, despite no differences in office, telehealth, or EMS transport. Understanding the complex effect of pandemic mitigation strategies on vulnerable populations can provide guidance for resource management in future crises.