Abstract
ObjectiveEmergency Department (ED) attendances with chest pain reduced during the COVID-19 lockdown. We performed a service evaluation project in NHS Lothian to explore how and why the COVID-19 pandemic and public health advice had affected chest pain presentations and help-seeking behaviour at an individual patient level using a qualitative interview approach.MethodsWe carried out 28 semi-structured telephone interviews with a convenience sample of patients who presented with chest pain during lockdown and in patients with known coronary heart disease under the outpatient care of a cardiologist in April and May 2020. Interviews were audio recorded and voice files listened to while making detailed notes. Salient themes and issues were documented as verbatim extracts. Interviews were analysed thematically.ResultsPatient interviews revealed three main themes. 1) pandemic help-seeking behaviour; describing how participants made the decision to seek professional healthcare assessment. 2) COVID-19 exposure concerns; describing how the subthemes of perceived vulnerability, wishing to protect others and adding pressure to the health service shaped their decision making for an episode of acute chest pain. 3) hospital experience; describing the difference between the imagined and actual experience in hospital.ConclusionsQualitative interviews revealed how the pandemic shaped help-seeking practices, how patients interpreted their personal vulnerability to the virus, and described patient experience of attending hospital for assessment during this time. As patient numbers presenting to hospital appeared to mirror public health messaging, dynamic monitoring of this messaging should evaluate public response to healthcare campaigns to ensure the net impact on health, pandemic and non-pandemic related, is optimised.
Highlights
IntroductionScotland is no different with NHS performance indicators reporting that Emergency Departments experienced a substantial reduction in attendances during government advice recommending strict social distancing during the COVID-19 pandemic [5]
Symptoms suggestive of acute coronary syndrome are one of the most common reasons for Emergency Department presentation [1]
2) COVID-19 exposure concerns; describing how the subthemes of perceived vulnerability, wishing to protect others and adding pressure to the health service shaped their decision making for an episode of acute chest pain. 3) hospital experience; describing the difference between the imagined and actual experience in hospital
Summary
Scotland is no different with NHS performance indicators reporting that Emergency Departments experienced a substantial reduction in attendances during government advice recommending strict social distancing during the COVID-19 pandemic [5] This has led to concerns that patients with significant illness such as myocardial infarction may not be attending hospital. Patients admitted to acute medical units in NHS Lothian, Scotland, during the first 31 days after lockdown were of higher medical acuity and had a higher risk of inpatient mortality when compared to patients in the same period in the preceding 5 years [7] This suggests that patients may not have been seeking and accessing healthcare in the same way as prior to the COVID-19 outbreak. It is imperative that patients with chest pain seek professional healthcare assessment for what could potentially be a medical emergency which, if not treated, can lead to life threatening complications such as heart failure, arrhythmia and death
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