Hospitalized US patients who had a type of heart attack called non–ST segment elevation myocardial infarction (NSTEMI) were at a 51% higher risk of death by 30 days and 32% higher risk of release to non-home settings amid COVID-19 patient surges than before, a University of Rochester–led research team reports.
For the study, published late last week in JAMA Network Open, the researchers analyzed Medicare data on 1,319,273 hospitalizations for heart attack from January 2016 to November 2020. The average patient age was 77 years, 44.0% were women, 81.8% were White, 9.3% were Black, and 8.9% were Hispanic.
NSTEMI typically results from severe narrowing or transient blockage of a coronary artery, while STEMI is the result of a complete and prolonged occlusion of coronary blood vessel.
No change in STEMI outcomes
Weekly hospitalizations for heart attack declined 5.2% early in the pandemic, with greater reductions in NSTEMI than STEMI admissions.
Among the 1,512,924 NSTEMI patients aged 65 and older, the adjusted odds of death and non-home discharges rose 51% and 32%, respectively, from before the pandemic, while the chances of revascularization surgery dropped 9% in weeks in which hospitals had COVID-19 patient surges of 30% or less and fell 27% in weeks with greater surges.
These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased.
Black NSTEMI patients experienced a clinically insignificant 7% higher increase in the odds of death for each 10% increase in the COVID-19 hospital burden but no increases in readmissions or non-home releases or declines in revascularization rates compared with their White peers.
Relative to White NSTEMI patients, there were no differential increases in poor outcomes among Hispanic patients based on hospital COVID-19 burden. COVID-19 patient surges were not tied to changes in outcomes or revascularization in STEMI overall or by racial group.
Need for policy, clinical interventions
"This study found that while hospital COVID-19 burden was associated with worse treatment and outcomes for NSTEMI, race and ethnicity–associated inequities did not increase significantly during the pandemic," the study authors wrote. "These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased."
The researchers said that the excess deaths may have primarily resulted due to delays in care, with patients seeking or receiving care later in their disease course because of limited care availability or concerns about COVID-19 infection in the healthcare setting.
"It is also possible that patients presenting with acute illnesses did not receive usual treatments due to staff or bed shortages," they wrote. "These findings suggest that policy and clinical interventions are needed to ensure that hospitals can continue to provide high-quality, evidence-based care for all patients, even in times of strain or stress."