Changes in clinical features and outcomes in three major critical diseases after COVID-19 pandemic: acute myocardial infarction, stroke, and cardiac arrest
1Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Gyeonggi-do, Republic of Korea
Submitted: 07 September 2021 Accepted: 10 November 2021
Online publish date: 29 December 2021
A few months after the onset of the coronavirus Disease 2019 (COVID-19) pandemic, the worse prognoses of acute myocardial infarction, ischemic and hemorrhagic stroke, and cardiac arrest were reported. This study aimed to investigate the changes in the characteristics and prognoses of these diseases in the emergency department (ED) over a year after pandemic’s onset. This was a retrospective observational study. The year 2019 was defined as the pre-period, while the year from February 2020 to January 2021 was defined as the post-period. Adult patients diagnosed with acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or cardiac arrest during the study period were included. The primary outcome was in-hospital mortality. Time series analyses using autoregressive integrated moving average (ARIMA)(p,d,q) model were performed to evaluate the changes between periods. A multivariable logistic regression analysis of factors affecting in-hospital mortality was performed. The proportions of patients with acute myocardial infarction (0.8% vs. 1.1%, p < 0.001), hemorrhagic stroke (1.0%vs. 1.2%, p = 0.011), and cardiac arrest (0.9% vs. 1.1%, p = 0.012) increased in the post-period. The post-period was independently associated with in-hospital mortality in acute myocardial infarction (adjusted odds ratio (aOR) 2.54, 95% confidence interval (95% CI) 1.06–6.08, p = 0.037) and hemorrhagic stroke (aOR 1.74, 95% CI 1.11–2.73, p = 0.016), but not for ischemic stroke or cardiac arrest. Over a year after onset of the COVID-19 pandemic in Korea, the number of patients with acute myocardial infarction, hemorrhagic stroke, and cardiac arrest in the ED increased. An independent association between the post-period and mortality was observed for acute myocardial infarction, and hemorrhagic stroke. This study provides important information for future studies and policies.
COVID-19; Emergency department; Acute myocardial infarction; Stroke; Cardiac arrest
Hyung Joo Lim,Jonghak Park,Juhyun Song,Sungwoo Moon,Jooyeong Kim,Hanjin Cho,Sejoong Ahn. Changes in clinical features and outcomes in three major critical diseases after COVID-19 pandemic: acute myocardial infarction, stroke, and cardiac arrest. Signa Vitae. 2022.doi:10.22514/sv.2021.250.
 Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020; 382: 1708–1720.
 Pak YS, Ro YS, Kim SH, Han SH, Ko SK, Kim TH, et al. Effects of Emergency Care-related Health Policies during the COVID-19 Pandemic in Korea: a Quasi-Experimental Study. Journal of Korean Medical Science. 2021; 36: e121.
 Westgard BC, Morgan MW, Vazquez-Benitez G, Erickson LO, Zwank MD. An Analysis of Changes in Emergency Department Visits after a State Declaration during the Time of COVID-19. Annals of Emergency Medicine. 2020; 76: 595–601.
 Jang KM, Ahn JY, Choi HJ, Lee SH, Kim DS, Lee DW, et al. Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea. Journal of Korean Medical Science. 2021; 36: e11.
 Diaz A, Sarac BA, Schoenbrunner AR, Janis JE, Pawlik TM. Elective surgery in the time of COVID-19. The American Journal of Surgery. 2020; 219: 900–902.
 Kim Y, Ahn E, Lee S, Lim D, Kim A, Lee S, et al. Changing Patterns of Medical Visits and Factors Associated with No-Show in Patients with Rheumatoid Arthritis during COVID-19 Pandemic. Journal of Korean Medical Science. 2020; 35: e423.
 O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127: e362–e425.
 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344–e418.
 Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabanas JG, et al. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation during Cardiac Arrest: an Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019; 140: e881–e894.
 Chan PS, Girotra S, Tang Y, Al-Araji R, Nallamothu BK, McNally B. Outcomes for out-of-Hospital Cardiac Arrest in the United States during the Coronavirus Disease 2019 Pandemic. JAMA Cardiology. 2021; 6: 296.
 Sung HK, Paik JH, Lee YJ, Kang S. Impact of the COVID-19 Outbreak on Emergency Care Utilization in Patients with Acute Myocardial Infarction: A Nationwide Population-Based Study. Journal of Korean Medical Science. 2021; 36: e111.
 Primessnig U, Pieske BM, Sherif M. Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID-19 pandemic. ESC Heart Failure. 2021; 8: 333–343.
 Gabet A, Grave C, Tuppin P, Chatignoux E, Béjot Y, Olié V. Impact of the COVID-19 pandemic and a national lockdown on hospitalizations for stroke and related 30‐day mortality in France: a nationwide observational study. European Journal of Neurology. 2021; 28: 3279–3288.
 Korean Society of Infectious Diseases, Korean Society of Pediatric Infectious Diseases, Korean Society of Epidemiology, Korean Society for Antimicrobial Therapy, Korean Society for Healthcare-associated Infection Control and Prevention, Korea Centers for Disease Control and Prevention. Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. Journal of Korean Medical Science. 2020; 35: e112.
 Zeger SL, Irizarry R, Peng RD. On Time Series Analysis of Public Health and Biomedical Data. Annual Review of Public Health. 2006; 27: 57–79.
 Huh K, Kim YE, Radnaabaatar M, Lee DH, Kim DW, Shin SA, et al. Estimating Baseline Incidence of Conditions Potentially Associated with Vaccine Adverse Events: a Call for Surveillance System Using the Korean National Health Insurance Claims Data. Journal of Korean Medical Science. 2021; 36: e67.
 Rubaihayo J, Tumwesigye NM, Konde-Lule J, Makumbi F. Forecast analysis of any opportunistic infection among HIV positive individuals on antiretroviral therapy in Uganda. BMC Public Health. 2016; 16: 766.
 Bonnet G, Panagides V, Becker M, Riviere N, Yvorel C, Deney A, et al. ST-Segment Elevation Myocardial Infarction: Management and Association with Prognosis during the COVID-19 Pandemic in France. Archives of Cardiovascular Diseases. 2021; 114: 340–351.
 Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, et al. Emergency department visits for emergent conditions among older adults during the COVID‐19 pandemic. Journal of the American Geriatrics Society. 2021; 69: 1713–1721.
 John S, Hussain SI, Piechowski-Jozwiak B, Dibu J, Kesav P, Bayrlee A, et al. Clinical Characteristics and Admission Patterns of Stroke Patients during the COVID-19 Pandemic: A Single Center Retrospective, Observational Study from Abu Dhabi, United Arab Emirates. Clinical Neurology and Neurosurgery. 2020; 199: 106227.
 Lee S heon, Jang J Sung, Chung JW, Kwon JT, Park YS. Clinical Pathway for Emergency Brain Surgery during COVID-19 Pandemic and Its Impact on Clinical Outcomes. Journal of Korean Medical Science. 2021; 36: e16.
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