#VisualAbstract: Increased proportion of out of hospital cardiac arrests at start at COVID-19

1. The proportion of out of hospital cardiac arrests (OHCAs) within all acute myocardial infarction (AMI) hospital admissions was higher at the start of the COVID-19 pandemic compared to before, by a difference of 2.0%.

2. The in-hospital mortality rate for OHCAs during COVID-19 was higher than before, by a difference of 9.9%.

Evidence Rating Level: 2 (Good)

During the COVID-19 pandemic, it was observed that hospitalizations for acute myocardial infarction (AMI) were reduced, whereas out of hospital cardiac arrests (OHCAs) were increased. For instance, research from Italy found a 50% decrease in AMI hospitalizations, and a separate study found a 58% increase in OHCAs during the outbreak. This may perhaps be due to increased public concern about visiting the hospital, for fear of contracting COVID-19. However, there is potentially an increased risk for death from OHCAs due to a delay in reperfusion treatment and other interventions. The current study compared the characteristics and outcomes of OHCA-related AMI hospital admissions, both prior to and during COVID-19. This study examined nationwide acute coronary syndrome data and percutaneous coronary intervention data from the UK. The population consisted of adults diagnosed with AMI from February to May 2019 (for the pre-COVID group) and from February to May 2020 (for the COVID group). Overall, the study found that 5.6% of all AMI hospital admissions were related to OHCA during the pandemic, whereas 3.6% of were OHCA-related in the pre-COVID group. There were significantly more AMI hospital admissions in the pre-COVID period, with 20,310 admissions compared to 9,235. In terms of outcomes, the COVID group had higher in-hospital mortality (27.8% vs 37.7%, p < 0.001), took longer to initiate reperfusion treatment (mean 2.1 hours vs 1.1 hours, p = 0.05), and were less likely to have an invasive coronary angiography investigation (58.4% vs 71.6%, p < 0.001). Altogether, this study demonstrates the increase in proportion of OHCA-related hospital admissions, and worse outcomes for these admissions, which underlies the need to promote public awareness and improve access to cardiac care during the ongoing pandemic.

Click to read the study in JAHA

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