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Heart attacks during COVID-19 more likely to result in heart failure
According to a study presented at the online Heart Failure 2021 congress, people who had a heart attack (myocardial infarction) during the COVID-19 pandemic were more likely to develop heart failure compared with those who had a heart attack before the pandemic. Study authors Dr Ali Aldujeli (Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania) and colleagues state that this may relate to people delaying seeking treatment during the pandemic.
Aldujeli et al, for the retrospective, multicentre study, reviewed data for consecutive patients with acute myocardial infarction — all of whom had a negative COVID-19 test — between 11 March and 20 April 2020 and underwent invasive treatment (covering six out of 10 administrative regions in Lithuania). They then compared these data with patients admitted with the same diagnosis during the same period in 2019. Patients were followed up for six months following hospital discharge. The authors looked at treatment delays, post-treatment ejection fraction, and decompensated heart failure hospitalisation rate in heart attack patients before vs. during the COVID-19 pandemic.
A total of 269 patients were evaluated. There was a 34% decline in heart attack admissions during the early phase of the pandemic compared to the same period in 2019, with patients waiting significantly longer before presenting to hospital during the pandemic compared with 2019 (a median of 858 vs. 386 minutes, respectively).
Furthermore, admission rates and delays were less pronounced for heart attacks with complete blockage of the heart arteries (ST-elevation myocardial infarction; STEMI) compared to non-STEMI. Admission rates fell by 22.1% for STEMI and 47.4% for non-STEMI. Patient delays more than doubled for STEMI patients during the pandemic and increased by more than fourfold for non-STEMI patients.
Post-treatment pump function was significantly lower during the pandemic compared to 2019. At six months, 22% of patients who had a heart attack during the pandemic were admitted to the hospital with decompensated heart failure compared with 2.5% in 2019.
When the authors examined the results by type of heart attack, they found that at six months, nearly one-third of patients (30%) who had non-STEMI during the pandemic were admitted to the hospital for decompensated heart failure compared to 1.3% in 2019. For STEMI, the corresponding proportions of admissions were 16.4% during the pandemic vs. 3.5% in 2019.
Dr Aldujeli says: “Heart attack patients waited an average of 14 hours to get help during the pandemic, with some delaying for nearly two days. That compares to a delay of six hours in the previous year. This gap may have been one contributor to the higher incidence of subsequent heart failure.” He added that declines in admissions and delays in seeking treatment “may be partly attributed to the extensive media coverage which amplified patients’ fear of contracting COVID-19 and precluded them from seeking timely medical care”.
Urgent treatment for heart attacks is essential to restore the flow of oxygen-rich blood to the heart muscle. A longer duration of oxygen deprivation is associated with a greater area of damaged muscle and reduced pump function (called ejection fraction), which is a type of heart failure. This is also true of person who has had a sudden cardiac arrest (when the heart stops completely). A delay in treatment — CPR and a defibrillator — not only reduces their chance of survival but also (if they do survive) increases their risk of permanent damage. For more information about what to do in the event of a sudden cardiac arrest, visit: www.defibsSaveLives.org