Abstract
Background: Infectious control measures during the COVID-19 pandemic have led to the propensity toward telemedicine. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients.Methods: This study included 288 patients admitted 1 year before the pandemic (October 2018–December 2018) and during the pandemic (January 2020–March 2020) eras, and survived their index STEMI admission. The follow-up period was 1 year. One-year primary safety endpoint was all-cause mortality. Secondary safety endpoints were cardiac readmissions for unplanned revascularisation, non-fatal myocardial infarction, heart failure, arrythmia, unstable angina. Major adverse cardiovascular events (MACE) was defined as the composite outcome of each individual safety endpoint.Results: Despite unfavorable in-hospital outcomes among patients admitted during the pandemic compared to pre-pandemic era, both groups had similar 1-year all-cause mortality (11.2 vs. 8.5%, respectively, p = 0.454) but higher cardiac-related (14.1 vs. 5.1%, p < 0.001) and heart failure readmissions in the pandemic vs. pre-pandemic groups (7.1 vs. 1.7%, p = 0.037). Follow-up was more frequently conducted via teleconsultations (1.2 vs. 0.2 per patient/year, p = 0.001), with reduction in physical consultations (2.1 vs. 2.6 per patient/year, p = 0.043), during the pandemic vs. pre-pandemic era. Majority achieved guideline-directed medical therapy (GDMT) during pandemic vs. pre-pandemic era (75.9 vs. 61.6%, p = 0.010). Multivariable Cox regression demonstrated achieving medication target doses (HR 0.387, 95% CI 0.164–0.915, p = 0.031) and GDMT (HR 0.271, 95% CI 0.134–0.548, p < 0.001) were independent predictors of lower 1-year MACE after adjustment.Conclusion: The pandemic has led to the wider application of teleconsultation, with increased adherence to GDMT, enhanced medication target dosing. Achieving GDMT was associated with favorable long-term prognosis.
Highlights
The coronavirus-2019 (COVID-19) pandemic has demanded the rapid adaptation of healthcare operations in implementing measures to reduce the infectious rate but to maintain the standard of patient care
The time period for the pre-pandemic group was carefully chosen to allow a control with the closest temporal proximity to the COVID-19 pandemic period, without its 1-year post-segment elevation myocardial infarction (STEMI) follow-up being affected by the pandemic
Despite the unfavorable in-hospital STEMI metrics of patients admitted during the pandemic, their 1-year mortality rate was similar to those admitted during the pre-pandemic era
Summary
The coronavirus-2019 (COVID-19) pandemic has demanded the rapid adaptation of healthcare operations in implementing measures to reduce the infectious rate but to maintain the standard of patient care. Patients with cardiovascular disease are at increased risk of contracting the COVID-19 infection with a poorer outcome [1]. The universally adopted strategy of social distancing as a measure to “flatten the curve” have resulted in a decrease in traditional physical consultations and the wider adaptation of teleconsultations. Teleconsultations, or telemedicine in general, offers virtual clinic consultations and monitoring which has gained traction as appropriate viable alternative for safe and efficient medical care. As the application of telemedicine expands, it becomes increasingly important to understand its impact on patient care and clinical outcomes. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients
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