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Impact of COVID-19 outbreak on regional STEMI care in Germany

Observational Study

Affiliations

• ¹ Department of Cardiology, Medizinische Klinik I, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany. k.scholz@bernward-khs.de.
• ² Department of Cardiology, University of Würzburg and Comprehensive Heart Failure Center Würzburg, Medizinische Klinik und Poliklinik I, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
• ³ Department of Internal Medicine I, Division of Cardiology, University Hospital of Augsburg, Stenglinstr.2, 86156, Augsburg, Germany.
• ⁴ Department of Cardiology, Rems-Murr-Kliniken GmbH, Am Jakobsweg 1, 71364, Winnenden, Germany.
• ⁵ Department of Cardiology, Klinikum Ludwigsburg-Bietigheim gGmbH, Posilipostraße 4, 71640, Ludwigsburg, Germany.
• ⁶ Department of Cardiology, St. Antonius Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Germany.
• ⁷ Department of Cardiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
• ⁸ Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Am Klinikum 1, 07740, Jena, Germany.
• ⁹ Department of Cardiology, Hermann-Josef-Hospital Erkelenz, Tenholter Str. 43, 41812, Erkelenz, Germany.
• ¹⁰ Department of Cardiology, University of Aachen, Medizinische Klinik I, Pauwelsstraße 30, 52074, Aachen, Germany.
• ¹¹ Department of Cardiology, Kliniken Maria Hilf GmbH Mönchengladbach, Viersener Strasse 450, 41063, Mönchengladbach, Germany.
• ¹² Department of Cardiology, Allgemeines Krankenhaus Viersen GmbH, Hoserkirchweg 63, 41747, Viersen, Germany.
• ¹³ Department of Cardiology, Medizinische Klinik I, Klinikum Ingolstadt, Krumenauerstraße 25, 85049, Ingolstadt, Germany.
• ¹⁴ Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Humboldtallee 32, 37073, Göttingen, Germany.
• ¹⁵ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, and DZHK, Partner Site Göttingen, Waldweg 33, 37073, Göttingen, Germany.

• PMID: 32676681
• PMCID: PMC7364412
• DOI: 10.1007/s00392-020-01703-z

Item in Clipboard

Observational Study

Karl Heinrich Scholz et al. Clin Res Cardiol. 2020 Dec.

• ¹ Department of Cardiology, Medizinische Klinik I, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany. k.scholz@bernward-khs.de.
• ² Department of Cardiology, University of Würzburg and Comprehensive Heart Failure Center Würzburg, Medizinische Klinik und Poliklinik I, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
• ³ Department of Internal Medicine I, Division of Cardiology, University Hospital of Augsburg, Stenglinstr.2, 86156, Augsburg, Germany.
• ⁴ Department of Cardiology, Rems-Murr-Kliniken GmbH, Am Jakobsweg 1, 71364, Winnenden, Germany.
• ⁵ Department of Cardiology, Klinikum Ludwigsburg-Bietigheim gGmbH, Posilipostraße 4, 71640, Ludwigsburg, Germany.
• ⁶ Department of Cardiology, St. Antonius Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Germany.
• ⁷ Department of Cardiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
• ⁸ Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Am Klinikum 1, 07740, Jena, Germany.
• ⁹ Department of Cardiology, Hermann-Josef-Hospital Erkelenz, Tenholter Str. 43, 41812, Erkelenz, Germany.
• ¹⁰ Department of Cardiology, University of Aachen, Medizinische Klinik I, Pauwelsstraße 30, 52074, Aachen, Germany.
• ¹¹ Department of Cardiology, Kliniken Maria Hilf GmbH Mönchengladbach, Viersener Strasse 450, 41063, Mönchengladbach, Germany.
• ¹² Department of Cardiology, Allgemeines Krankenhaus Viersen GmbH, Hoserkirchweg 63, 41747, Viersen, Germany.
• ¹³ Department of Cardiology, Medizinische Klinik I, Klinikum Ingolstadt, Krumenauerstraße 25, 85049, Ingolstadt, Germany.
• ¹⁴ Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Humboldtallee 32, 37073, Göttingen, Germany.
• ¹⁵ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, and DZHK, Partner Site Göttingen, Waldweg 33, 37073, Göttingen, Germany.

• PMID: 32676681
• PMCID: PMC7364412
• DOI: 10.1007/s00392-020-01703-z

Item in Clipboard

Aims: To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients.

Methods: Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020.

Results: There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = - 2.2-2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = - 4.9-7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = - 6.2-7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = - 3.2-4.5, p = 0.739).

Conclusions: Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic.

Clinical trial registration: NCT00794001.

Keywords: COVID-19; Contact-to-balloon time; Key quality indicators; Mortality; Percutaneous coronary intervention (PCI); ST-segment elevation myocardial infarction (STEMI).

PubMed Disclaimer

Tim Friede reports personal fees from Novartis, Bayer, Janssen, SGS, Roche, Boehringer Ingelheim, Daiichi-Sankyo, Galapagos, Penumbra, Parexel, Vifor, BiosenseWebster, CSL Behring, Fresenius Kabi, Coherex Medical, and LivaNova; all outside the submitted work. All other authors declare no conflict of interest.

Catchment area maps showing home…

Catchment area maps showing home postcodes for all STEMI patients included in the…

Catchment area maps showing home postcodes for all STEMI patients included in the FITT-STEMI study (a) and regional hot spots of the COVID-19 outbreak during the initial phase of the epidemic in Germany (b). The maps depict the overlap of the two distributions particularly in the Lower Rhine area in North-West Germany

Modes of admission to hospitals…

Modes of admission to hospitals for STEMI patients during the corona virus crisis.…

Modes of admission to hospitals for STEMI patients during the corona virus crisis. a Total numbers of STEMI patients admitted to PCI hospitals by the indicated modes in March 2020 compared to the March months in the three preceding years 2017–2020. b Increased percentage of patients admitted by emergency medical service (EMS) during the COVID-19 outbreak in March 2020 as compared to the previous March months in 2017–2019, whereas the proportion of non-EMS transports was reduced

Percentages of achieved key quality…

Percentages of achieved key quality indicators for STEMI treatment over the 39-month period…

Percentages of achieved key quality indicators for STEMI treatment over the 39-month period from January 2017 to March 2020 in all the 41 participating FITT-STEMI study centres (a) and a subgroup thereof with seven centers in the Lower Rhine area heavily engaged in fighting the SARS-CoV-2 pandemic (b). March months are indicated by the red letter “M”. The last point in each curve corresponds to the lockdown month with high COVID-19 case numbers (March 2020)

Monthly contact-to-balloon times, as presented…

Monthly contact-to-balloon times, as presented by their means and standard errors of the…

Monthly contact-to-balloon times, as presented by their means and standard errors of the mean, in STEMI patients treated within 360 min from first medical contact to balloon inflation in the total study group (a) and the subgroup of clinics in the Lower Rhine area with high case numbers of COVID-19 (b). The last point in each curve corresponds to the lockdown March month 2020 with a high prevalence of COVID-19 in Germany

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