Source / Information
Wijns W, et al. Primary PCI: New problems, new solutions. Presented at: EuroPCR; 17-20 May 2022; Paris (hybrid meeting).
Information: Wijns reports being a co-founder of Argonauts and receiving research fellowships and fees from MicroPort.
Postponement or discontinuation of STEMI treatment during the first COVID-19 related lockdown in England was associated with approx. 2 lost years of life per. patient vs. pre-lockdown modes according to a model analysis presented at EuroPCR.
In an analysis to predict the potential clinical and financial burden associated with reductions in PCI treatment access during the COVID-19 lockdown in the UK, researchers said the difference was primarily driven by the reduced hospitalization rate at the start of lockdown and by a higher mortality rate long-term for untreated survivors.
“We spend a lot of time trying to convince authorities and regulators that if you implement new treatments, there will be an impact on patient outcomes,” William Wijns, MD, said the Science Foundation Ireland Professor of Interventional Cardiology at the Lambe Institute for Translational Medicine, Curam and Saolta University Healthcare Group, National University of Ireland, Galway, during a press conference. “Here we had an unfortunate attempt where existing care was removed [during lockdown]. This allows us to look at the impact. ”
Modeling of STEMI patient data
Wijns and colleagues developed a decision analysis model to predict outcomes for STEMI that occurred during the first UK lockdown from March to April 2020, comparing rates with expected pre-lockdown outcomes for a similar patient group. The model incorporated probability of hospitalization, timeliness of treatment and expected long-term survival and morbidity as well as associated costs and the impact on HF for untreated patients.
“Some authorities in many countries issued in-house orders, and of course the hospitals completely reorganized their care process. … CV treatments were postponed, delayed or did not even take place,” said Wijns. “The most acute part of it was the reduction of treatment in patients with STEMI. “
The researchers stratified patients by hospitalization status; the inmates were designated for timely or late PCI; non-hospitalized patients did not receive PCI within 30 days. Researchers estimated 30-day mortality for each case; patients then entered the long-term survival model with results based on treatment status.
The model predicted an average loss of 1.86-year survival for a patient who had a STEMI during the first month of lockdown compared to pre-lockdown, with a corresponding loss of 1.46 of quality-adjusted life years, according to researchers. Upscale to a population level, the results translated into a loss of 4,912 years of survival with a corresponding loss of 3,856 QALYs.
This means that having a STEMI during the COVID-19 lockdown period caused an average loss of almost 2 years of life per patient compared to a person who had a STEMI before lockdown, primarily driven by the reduced hospitalization rate at baseline of the lockdown, but also due to higher mortality over time because untreated patients suffer from more complications, “said Wijns.” They move into HF more often and have more severe arrhythmias. “
Experiences from lockdowns
Wijns called the impact of the COVID-19 lockdown on STEMI admissions and PCI use “significant,” leading to poorer patient outcomes, including increased mortality, more HF, higher societal costs, and lower QALYs.
STEMI admissions recovered quickly; however, there was a similar removal of care during the second wave of COVID-19 lockdowns in the UK in November 2020, Wijns said. During a Q&A session after the press conference, Wijns said he hoped clinicians and researchers would “learn from” the data.
“For example, unpreparedness would no longer be an issue if the ensuing waves [of COVID-19] hit us, ”said Wijns. “We want to have an impact on hospitals and doctors, but we also want to make a list of diseases where treatment could not be stopped or interrupted. There would be a plan so we would not be surprised. ”
Wijns added that the data also underscored the importance of nurses and related health professionals.
“We still see that some cath laboratories have not returned to normal due to the lack of nurses and allied professionals,” he said.
As Healio has previously reported, The Society for Cardiovascular Angiography and Interventions, the American College of Cardiology and the American College of Emergency Physicians issued a consensus statement in April 2020 that primary PCI should remain the standard of care for patients with STEMI during the COVID-19 pandemic. The statement noted that all patients with suspected STEMI should be treated as COVID-19 possible, additional patients should be transferred to the cardiac catheterization laboratory as soon as possible, although more time may be needed to establish an acute MI diagnosis and / or perform a COVID -19 status assessment and treatment.
Wijns said further STEMI data from France, Spain, Sweden and the US are on the way; researchers also hope to extend the analysis to other countries and other disease areas.