Impact of COVID-19 pandemic lockdown on myocardial infarction care

Ute Amann,Christa Meisinger,Inge Kirchberger,Timo Schmitz,Sebastian E. Baumeister,Christian Thilo,Jakob Linseisen

doi:10.1007/s10654-021-00764-2

Abstract

The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on acute myocardial infarction (AMI) care, and to identify underlying stressors in the German model region for complete AMI registration. The analysis was based on data from the population-based KORA Myocardial Infarction Registry located in the region of Augsburg, Germany. All cases of AMI (n = 210) admitted to one of four hospitals in the city of Augsburg or the county of Augsburg from February 10th, 2020, to May 19, 2020, were included. Patients were divided into three groups, namely pre-lockdown, strict lockdown, and attenuated lockdown period. An additional survey was conducted asking the patients for stress and fears in the 4 weeks prior to their AMI. The AMI rate declined by 44% in the strict lockdown period; in the attenuated lockdown period the rate was 17% lower compared to the pre-lockdown period. The downward trend in AMI rates during lockdown was seen in STEMI and NSTEMI patients, and independent of sex and age. The door-to-device time decreased by 70–80% in the lockdown-periods. In the time prior to the infarction, patients felt stressed mainly due to fear of infection with Sars-CoV-2 and less because of the restrictions and consequences of the lockdown. A strict lockdown due to the Covid-19 pandemic had a marked impact on AMI care even in a non-hot-spot region with relatively few cases of COVID-19. Fear of infection with the virus is presumably the main reason for the drop in hospitalizations due to AMI.

Highlights

Since the first reported case of Covid-19 on January 27, 2020, in Bavaria, [1] Germany, the number of confirmed cases increased rapidly in early March
The acute myocardial infarction (AMI) rate declined by 44% in the first period after lockdown compared to the pre-lockdown phase (Table 2)
During the second post-lockdown period, the rate was 17% lower compared to the pre-lockdown period (RR = 0.83, 95% confidence intervals (CI) 0.70–0.96)

Summary

Introduction

Since the first reported case of Covid-19 on January 27, 2020, in Bavaria, [1] Germany, the number of confirmed cases increased rapidly in early March. The exponential increase in newly confirmed cases reached a total of 67,366 positively tested cases on April 1 in whole Germany [2] and 20,178 cases in Bavaria, the German federal state most affected by Covid-19. Population-based KORA Myocardial Infarction Registry in Augsburg, [8] Germany, covering all AMI events in a region of about 680,000 inhabitants. We examined possible stressors that prevented acute heart attack patients from seeking immediate inpatient treatment

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