Background

Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic.

Methods

We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs.

Findings

Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37–43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38–46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12–29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29–45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2–9) in 2019 to 3 days (1–5) by the end of March, 2020.

Interpretation

Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses.

Funding

UK Medical Research Council, British Heart Foundation, Public Health England, Health Data Research UK, and the National Institute for Health Research Oxford Biomedical Research Centre.

中文翻译：

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英国 COVID-19 大流行以及急性冠状动脉综合征的入院率和管理。

背景

几个受 COVID-19 大流行影响的国家报告说，因急性冠脉综合征到急诊科就诊的患者人数大幅下降，心脏手术数量也有所减少。我们旨在了解英格兰不同类型急性冠脉综合征入院变化的规模、性质和持续时间，并评估患者的住院管理是否因 COVID-19 大流行而受到影响。

方法

我们分析了 2019 年 1 月 1 日至 2020 年 5 月 24 日期间英格兰因急性冠脉综合征类型住院的数据，这些数据记录在二次使用服务入院患者护理数据库中。入院分为 ST 段抬高型心肌梗死 (STEMI)、非 STEMI (NSTEMI)、不明类型心肌梗死或其他急性冠状动脉综合征（包括不稳定型心绞痛）。我们确定了在这些入院期间进行的血运重建程序（即没有经皮冠状动脉介入术 [PCI] 的冠状动脉造影术、PCI 和冠状动脉搭桥手术）。我们计算了每周入院的人数和进行的程序；还计算了每周入院和跨亚组的百分比减少，CI 为 95%。

发现

急性冠脉综合征入院人数从 2020 年 2 月中旬开始下降，从 2019 年基线水平的每周 3017 人次下降到 2020 年 3 月底的每周 1813 人次，减少了 40% (95% CI 37–43) . 这种下降在 2020 年 4 月和 5 月被部分逆转，因此到 2020 年 5 月的最后一周，有 2522 人入院，比基线减少 16%（95% CI 13-20）。在入院率下降期间，包括 STEMI 和 NSTEMI 在内的所有类型的急性冠脉综合征入院人数均有所减少，但 NSTEMI 的相对和绝对降幅更大，2019 年每周入院 1267 人次，每周 733 人次到 2020 年 3 月底，百分比减少 42% (95% CI 38–46)。在平行下，截至 2020 年 3 月底为346；减少百分比 21%，95% CI 12-29) 和 NSTEMI（2019 年每周 383 次 PCI 手术，到 2020 年 3 月底为 240 次；减少百分比 37%，29-45）。到 2020 年 3 月底，急性冠状动脉综合征患者的中位住院时间从 2019 年的 4 天（IQR 2-9）下降到 3 天（1-5）。

解释

与2019年周均值相比，2020年3月底英国急性冠脉综合征患者周入院人数大幅减少，2020年5月底部分逆转这段时期入院人数的减少，很可能导致院外死亡和心肌梗死远期并发症增加，错失冠心病患者二级预防治疗的机会。将通过更新这些分析来继续评估 COVID-19 对急性冠状动脉综合征患者管理的影响的全部程度。

资金

英国医学研究委员会、英国心脏基金会、英国公共卫生部、英国健康数据研究中心和国家卫生研究院牛津生物医学研究中心。