Emergency activations for chest pain and ventricular arrhythmias related to regional COVID-19 across the US

Sidney Aung,N Clay Mann,Anthony Lin,Gregory M Marcus,Eric Vittinghoff,Gregory Nah,Sean Joyce

doi:10.1038/s41598-021-03243-6

Abstract

Evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened the concern that true rates of myocardial infarctions have been under-ascertained and left untreated. We analyzed data from the National Emergency Medical Services Information System (NEMSIS) and incident COVID-19 infections across the United States (US) between January 1, 2020 and 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 cardiovascular activations. After multivariable adjustment, increasing COVID-19 rates were associated with less activations for chest pain and non-ST-elevation myocardial infarctions. Simultaneously, increasing COVID-19 rates were associated with more activations for cardiac arrests, ventricular fibrillation, and ventricular tachycardia. Although direct effects of COVID-19 infections may explain these discordant observations, these findings may also arise from patients delaying or avoiding care for myocardial infarction, leading to potentially lethal consequences.

Highlights

Evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened the concern that true rates of myocardial infarctions have been under-ascertained and left untreated
After adjustment for calendar day of week, calendar month, and United States (US) Census Division, there was a significant decrease in chest pain events with increasing COVID-19 rates (RR 0.67, 95% CI 0.63–0.70, p < 0.001; Fig. 1)
After adjustment for the same covariates and over the same time period, there was a significant increase in cardiac arrest with increasing COVID-19 (RR 1.51, 95% CI 1.36–1.68, p < 0.001; Fig. 1)

Summary

Introduction

Evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened the concern that true rates of myocardial infarctions have been under-ascertained and left untreated. Acute COVID-19 has been associated with a systemic inflammatory cytokine response that can directly contribute to coronary artery plaque rupture, activation of procoagulant factors, and hemodynamic changes that may predispose to ischemia, thrombosis, and myocardial infarction[2,3,4], several investigators have paradoxically reported marked declines in the incidence of myocardial infarctions during the COVID-19 pandemic[5,6,7,8,9,10] Further bolstering these findings, there have been decreasing cardiac catheterization laboratory activations and percutaneous coronary interventions over the same time period[10,11,12]. In order to test the hypothesis that increased rates of COVID-19 would be simultaneously associated with a decline in emergency medical services (EMS) activations for chest pain and myocardial infarction with a concomitant rise in activations for cardiac arrests and malignant ventricular arrhythmias, we sought to characterize patterns of each of these phenomena in relationship to SARS-CoV-2 infections throughout the US

Methods

Results

Discussion

Conclusion