Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data.
Chammas L., Yuan K., Little S., Roadknight G., Varnai KA., Chang SC., Sze S., Davies J., Tsui A., Salih H., Glampson B., Papadimitriou D., Mulla A., Woods K., O'Gallagher K., Shah AD., Williams B., Asselbergs FW., Mayer E., Lee R., Herbert C., Johnson T., Grant S., Curzen N., Shah AM., Perera D., Patel RS., Channon KM., Kaura A., Mayet J., Eyre DW., Squire I., Kharbanda R., Lewis A., Wijesurendra RS.
ObjectiveThe COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.MethodsMulticentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).ResultsDuring the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p p = 0.001) and dyspnoea (p p p p ConclusionsThe first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.