An important reduction in the activity in interventional cardiology has been observed during the COVID-19 epidemic according to a recent study in REC Interventional Cardiology1.
The authors carried out a survey in 81 centres involved in ST-elevation myocardial infarction (STEMI) networks in the 17 autonomous communities of Spain. Information was collected on diagnostic activity, percutaneous coronary intervention (PCI), structural interventions, and PCI in STEMI on changes in the organization of STEMI networks, and on the prevalence of COVID-19 among interventional cardiologists. Data was compared for the week of February 24 through March 1 (before the outbreak) and for the week of March 16 through March 22 (during the outbreak). A significant decrease in the number of diagnostic procedures (─57%), PCI (─48%), structural interventions (─81%) and PCI in STEMI (─40%) has been observed. A slight increase in the use of pharmacological thrombolysis has been reported, although primary angioplasty remains the leading reperfusion strategy. Of 339 medical professionals who perform primary angioplasty procedures, 17 presented COVID-19 infection (5%).
In this study, the time to reperfusion, the clinical characteristics, as well as in-hospital complications, were not analysed. And the report of the use of lithic, was made with a non-quantitative method, asking each centre if more thrombolytic therapy has been performed.
The COVID-19 pandemic caused by infection with the SARS-CoV-2 virus has put the Spanish health system in a situation of serious overload. On March 14, 2020, the state of alarm was declared in Spain with a house confinement of the population with the aim of slowing down the progression of the epidemic. As a consequence, attention to other pathologies could have been affected, and among them the treatment of cardiovascular diseases. This is especially important in emergencies such as STEMI. In a recently reviewed study in the Heart Blog, Tam, et al 2. described the timeliness of primary percutaneous coronary intervention for STEMI in a single centre in Hong Kong, China. They reported an approximately 3-fold increase in the time from symptom onset to medical contact.
Scientific societies and health authorities have to promote that patients presenting STEMI compatible symptoms should proceed with no delay to access the health system to receive reperfusion treatment.
More studies are needed to assess whether this phenomenon occurs in other parts of the world, and to explore the factors that could explain the decrease of coronary interventions, especially in STEMI. From the World Heart Federation, we encourage to start studies that evaluate the impact of the pandemic on the health care of other cardiovascular diseases. To identify the barriers to cardiovascular disease care, and find possible solutions such as telephone advice lines or telemedicine.
References
1. Rodríguez-Leor O, Cid Alvarez B, Ojeda S et al. Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología intervencionista en España. REC Interv Cardiol. 2020. https://doi.org/10.24875/RECIC.M20000120
2. Tam CF, Cheung KS, Lam S, et al. 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.
The Heart in the Time of COVID-19 