Can the fear of COVID-19 lead to harmful delays in seeking care for cardiovascular emergencies?

by:
Darryl Leong

The impact of COVID-19 on the delivery of care for emergency cardiovascular illness is unknown. In this report, Tam, et al. describe the timeliness of primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI) in 7 consecutive patients presenting to a single centre in Hong Kong, China, between January 25, and February 10, 20201. The authors compared these data with those of 108 patients treated for STEMI from February 1, 2018 to January 31, 2019. They reported an approximately 3-fold increase in the time from symptom onset to medical contact. There was no marked difference in door-to-balloon time between the groups. While based on very limited data, this report raises concerns that public apprehension over the potential for hospital-acquired COVID-19 infection may lead to harmful delays in presentation for high-risk acute coronary syndromes. One might readily extrapolate these concerns to other cardiovascular emergencies, such as decompensated heart failure. The case-fatality for such cardiovascular emergencies, if there are substantial delays to treatment, is likely to be higher than the case-fatality from nosocomial infection with COVID-19. Therefore, public health messaging about the avoidance of unnecessary presentations to Emergency Departments should be worded so as not to discourage appropriate presentations. Ideally, adequately staffed telephone advice lines should be available to provide uncertain patients with rapid guidance.

References:
1. Tam CF, Cheung KS, Lam S, Wong A, Yung A, Sze M, Lam YM, Chan C, Tsang TC, Tsui M, Tse HF and Siu CW. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020:CIRCOUTCOMES120006631.

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