Prof Chris P Gale Profile picture
Aug 5, 2020 25 tweets 7 min read Read on X
More evidence of the devastating impact of @COVID19 on people’s lives. Reduction in admissions with #heartattack & early signal of higher rate of deaths. academic.oup.com/ehjqcco/articl…
Many have hypothesised that #COVID19 might have affected the care & outcomes of people with acute myocardial infarction (#heartattack). Therefore, we aimed to determine whether the #COVID19UK pandemic changed patient response, #hospital treatment & mortality from #heartattack .
We classified admissions as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in #England through live feeding from the Myocardial Ischaemia National Audit Project (#MINAP @CardiacAudit ) between 1st January, 2019 & 22nd May, 2020
We undertook descriptive analyses & estimated time series plots using a 7-day simple moving average, adjusted for seasonality.
From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020.
We have reported @TheLancet similar findings, but using English administrative data from @NHSDigital thelancet.com/journals/lance…
However, arising from that analysis, we speculated that reduced number of admissions may have resulted in increases in out-of-hospital deaths & long-term complications of #heartattack & missed opportunities to offer secondary prevention treatment
In the @CardiacAudit national #cardiovascular clinical registry analysis, we found that during #lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently #diabetic (24.6% vs. 28.1%) or had #cerebrovascular disease (7.0% vs. 8.6%).
Patients with STEMI more frequently received primary PCI (81.8% vs 78.8%%) & the use of thrombolysis was negligible (0.5% vs. 0.3%).
The median admission-to-coronary angiography duration for NSTEMI decreased substantially (26.2 vs. 64.0 hours).
Overall, the median duration of hospitalisation decreased (4 to 2 days).
Notably, the prescription of secondary prevention pharmacotherapies was very high & remained unchanged (each evidenced-based medication reached >94.7%).
..., but “what about deaths?”, I hear you shout...
Well, we linked our live feed national clinical registry data to the @ONS Civial Register of Deaths to estimate all-cause mortality at 30 days.
In the UK, all deaths must be certified & registered, & within a short period of time.
...”so what did it show?”...
So, we found that for patient ts admitted with STEMI their mortality at 30 days decreased from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97).
... “,but what about NSTEMI?”...
We found that for patients admitted with NSTEMI, their mortality at 30 days increased from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80).
...”why?”
Who knows? One can only speculate at this point. We have further work to do to understand this.
It’s possible that those admitted with NSTEMI were somehow different from the normal admissions with NSTEMI, perhaps they were more like to have #COVID19 infection, or there were implications of their reduced length of hospital stay, or rates or of an invasive coronary strategy?
Quotes from me:
“This national study provides evidence for the devastating impact that COVID19 has had on people’s lives”.
“The inflation in deaths among people attending hospital with heart attack is very likely an early signal of the mortality and morbidity that is yet to be observed”.
“Notably we have not seen a return to the normal rates of admissions with heart attack. This means that people may still be delaying seeking help”.@TheBHF

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More from @cpgale3

Sep 28, 2020
This nationwide complete analysis of all adult deaths in #England & #Wales has found that the #COVID pandemic has resulted in an abrupt inflation in acute #cardiovascular deaths above that expected for the time of year. heart.bmj.com/content/early/…
That is, about 2000 additional deaths over a 4 month period.
Nearly half of the deaths occurred outside of the #hospital setting, either at #home or in #carehomes.
Read 23 tweets
Sep 23, 2020
Emerging data from @PHE_uk suggests a synergistic detrimental effect of co-infection with #SARS_CoV_2 & #flu viruses. The preprint (not peer reviewed) article is available here medrxiv.org/content/10.110…
‘The risk of testing positive for #SARS_CoV_2 was 68% lower among #influenza positive cases, suggesting possible pathogenic competition between the two viruses.’
However, ‘Patients with a coinfection had a risk of death of 5.92 (95% CI, 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2 suggesting possible synergistic effects in coinfected individuals.’
Read 7 tweets
Sep 20, 2020
Advances in #cancer treatment have improved clinical outcomes, leading to an increasing population of cancer survivors. Yet, this success is associated with high rates of short‐ & long‐term #cardiovascular toxicities. The Cancer Patient and Cardiology onlinelibrary.wiley.com/doi/abs/10.100…
The number & variety of #cancer drugs & #cardiovascular toxicity types make long‐term care a complex undertaking.
This requires a multidisciplinary approach including expertise from #oncology, #cardiology, & other related specialties, & has led to the development of the cardio‐oncology subspecialty.
Read 10 tweets
Sep 20, 2020
The rise in admissions with #COVID19 does not mean that you shouldn’t attend hospital if you have a medical emergency #heartattack Image
During the first peak, admissions with #heartatrack declined & was of grave concern : COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England @TheLancet thelancet.com/journals/lance…
Yet, hospitals provided high quality care for those who did attend: Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic @ESC_Journals #EHJQCCO academic.oup.com/ehjqcco/advanc…
Read 6 tweets
Sep 19, 2020
Subsequent to #Surgisphere, all @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world #datasets. thelancet.com/journals/lance…
@TheLancet journals now require all #research papers, irrespective of method, to include a data-sharing statement that details what #data will be shared, whether additional documents will be shared, when data will become available & by what access criteria data will be shared.
All @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world datasets.
Read 10 tweets
Sep 19, 2020
Patients with mitral annular disjunction present with frequent premature ventricular contractions; in this study, one-third had ventricular arrhythmias & one-tenth had severe arrhythmic events. @JACCJournals onlinejacc.org/content/72/14/…
A total of 82 (71%) patients reported #palpitations, 47 (41%) patients reported previous pre-syncope, 40 (34%) had ventricular arrhythmia, 15 (13%) had experienced #syncope, & 14 (12%) patients had experienced a severe arrhythmic event prior to inclusion
Mitral valve prolapse was present in 90 (78%) patients
Read 10 tweets

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