1887
Volume 2023, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

The study sought to determine if the arrival of patients experiencing ST-segment elevation myocardial infarction (STEMI) or cerebrovascular accident to the emergency department (ED) was delayed due to fear of COVID-19, among other factors. Both these disease processes are time-dependent, and great efforts have been made to intervene in this pathology quickly to help improve patient-centered outcomes.

A retrospective, case-control study was conducted using data from patient records from March to June 2019 and March to June 2020 from Spring Valley Hospital in Las Vegas, Nevada, USA. Chi-square analyses were performed to determine whether times to presentation for STEMIs and embolic strokes differed between 2019 and 2020 and between March and June using the times to present during the months following the U.S. COVID-19 emergency declaration on March 13th, 2020 (March, April, May, and June). The 432 STEMI and 183 stroke activations were reported during these months.

The results displayed an increase in presentation time for STEMI complaints (χ2 [3, = 2289] = 109.8, < 0.01) and for stroke complaints (χ2 [3, = 1011] = 182.8, < 0.01). The increase in times to presentation for STEMI and embolic stroke patients in the months following the emergency declaration compared to the year prior suggests that patients delayed presentation to the ED.

During the pandemic, there was an increase in time to seek treatment for STEMI and embolic stroke patients from the onset of symptoms to their arrival at the ED. This was likely due to patients’ hesitancy to seek treatment due to fear of contracting COVID-19, scarce emergency medical services (EMS) resources, and the flux of new hospital-based virus screening. Data from stroke patients was more heterogenous, likely due to both patients and observers being able to activate the EMS system. These findings may support changes to future public health pandemic guidelines and health education.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2023.7
2023-02-06
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2023/1/jemtac.2023.7.html?itemId=/content/journals/10.5339/jemtac.2023.7&mimeType=html&fmt=ahah

References

  1. Aldama G, López M, Santás M, Flores X, Piñón P, Salgado J, et al. Impact on mortality after implementation of a network for ST-segment elevation myocardial infarction care. The IPHENAMIC study. Rev Esp Cardiol (Engl Ed). 2020; 73:(8):632–42. doi:10.1016/j.rec.2019.09.031.
    [Google Scholar]
  2. Otero D, Singam NSV, Barry N, Raheja P, Solankhi A, Solankhi N. Complication of late presenting STEMI due to avoidance of medical care during the COVID-19 pandemic. JACC Case Rep. 2020; 2:(10):1610–3. doi:10.1016/j.jaccas.2020.05.045.
    [Google Scholar]
  3. Zi W, Qiu Z, Li F, Sang H, Wu D, Weidong L, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: The DEVT randomized clinical trial. JAMA. 2021; 325:(3):234–43. doi:10.1001/jama.2020.23523.
    [Google Scholar]
  4. Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care. NEJM Catal Innov Care Deliv. 2020; 1:(3). doi:10.1056/CAT.20.0193.
    [Google Scholar]
  5. Ahmed T, Lodhi SH, Kapadia S, Shah GV. Community and healthcare system-related factors feeding the phe-nomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis. BMJ Case Rep. 2020; 13:(8):e237817. doi:10.1136/bcr-2020-237817.
    [Google Scholar]
  6. Moroni F, Gramegna M, Ajello S, Beneduce A, Baldetti L, Vilca LM, et al. Collateral damage: Medical care avoidance behavior among patients with myocardial infarction during the COVID-19 pandemic. JACC Case Rep. 2020; 2:(10):1620–4. doi:10.1016/j.jaccas.2020.04.010.
    [Google Scholar]
  7. Teo K-C, Leung WCY, Wong Y-K, Liu RKC, Chan AHY, Choi OMY, et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke. 2020; 51:(7):2228–31. doi:10.1161/STROKEAHA.120.030105.
    [Google Scholar]
  8. Erol MK, Kayıkçıoğlu M, Kılıçkap M, Güler A, Yıldırım A, Kahraman F, et al. Treatment delays and in-hospital out-comes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study. Anatol J Cardiol. 2020; 24:(5):334–42. doi:10.14744/AnatolJCardiol.2020.98607.
    [Google Scholar]
  9. Alsidawi S, Campbell A, Tamene A, Garcia S. Ventricular septal rupture complicating delayed acute myocardial infarction presentation during the COVID-19 pandemic. JACC Case Rep. 2020; 2:(10):1595–8. doi:10.1016/j.jaccas.2020.05.049.
    [Google Scholar]
  10. Kerleroux B, Fabacher T, Bricout N, Moïse M, Testud B, Vingadassalom S, et al. Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak: Decreased activity, and increased care delays. Stroke. 2020; 51:(7):2012–7. doi:10.1161/STROKEAHA.120.030373.
    [Google Scholar]
  11. Ventura C, Denton EE, Knauth CM. An overview of emergency medical services pandemic response in the United States and its implications during the era of COVID-19. SSRN Electron J. 2020. doi:http://dx.doi.org/10.2139/ssrn.3631136
    [Google Scholar]
  12. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med. 2020; 383:(5):496–8. doi:10.1056/NEJMc2010418.
    [Google Scholar]
  13. Trabattoni D, Montorsi P, Merlino L. Late STEMI and NSTEMI patients’ emergency calling in COVID-19 outbreak. Can J Cardiol. 2020; 36:(7):1161.e7–1161.e8. doi:10.1016/j.cjca.2020.05.003.
    [Google Scholar]
  14. Khot UN, Reimer AP, Brown A, Hustey FM, Hussain MS, Kapadia SR, et al. Impact of COVID-19 pandemic on crit-ical care transfers for ST-segment-elevation myocardial infarction, stroke, and aortic emergencies. Circ Cardiovasc Qual Outcomes. 2020; 13:(8):e006938. doi:10.1161/CIRCOUTCOMES.120.006938.
    [Google Scholar]
  15. Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, et al. The unequal burden of pain: con-fronting racial and ethnic disparities in pain. Pain Med. 2003; 4:(3):277–94. doi:10.1046/j.1526-4637.2003.03034.x.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2023.7
Loading
/content/journals/10.5339/jemtac.2023.7
Loading

Data & Media loading...

Keyword(s): COVID-19embolic strokepandemic and STEMI
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error