COVID-19 lockdown impact on quality of treatment and outcomes of STEMI and stroke patients in a large tertiary medical center: an observational study.

Abstract

BackgroundThe COVID-19 pandemic affected healthcare systems worldwide, leading to fewer admissions and raising concerns about quality-of-care. The objective of the study was to investigate the early effects of the COVID-19 pandemic on quality-of-care among stroke and ST-elevation myocardial infarction (STEMI) patients, focusing on clinical outcomes and direct treatment costs.MethodsThis retrospective, observational study was based on the 10-week period that included the first wave of the COVID-19 pandemic in Israel (2/15/2020–4/30/2020). Emergency department (ED) admissions for stroke and STEMI were compared to parallel periods in 2017–2019, focusing on demographics, risk and severity scores, and the effect of clinical outcomes on hospitalization costs.ResultsThe 634 stroke and 186 STEMI cases comprised 16% and 19% fewer admissions, respectively, compared to 2019. No significant changes were detected in demographics, most disease management parameters, readmission and mortality outcomes. Mean door-to-balloon time increased insignificantly by 33%, lowering the health quality indicator (HQI) for treatment in <90 minutes from 94.7% in 2017–2019 to 83% in 2020 (p=0.022). Among suspected stroke patients, 97.2% underwent imaging, with 28% longer median time from admission (p=0.05). Consequently, only 24.3% met the HQI of imaging in <29 minutes, compared to 45.5% in 2017–2019 (p<0.01). Increased length of stay and more intensive care unit admissions were the leading causes of 6.5% increased mean cost of STEMI patients’ initial hospitalization, which totalled $;29,300 in the COVID-19 period (p=0.008).ConclusionThe initial pandemic period caused a decline in HQI linked to diagnostic and treatment protocols, without changes in outcomes, but with increased hospital costs. Medical information and awareness of life-threatening conditions among patients and caregivers should be increased to enable proper diagnosis and management.