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Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data.
Chammas, Lara; Yuan, Kevin; Little, Stephanie; Roadknight, Gail; Varnai, Kinga A; Chang, Shing Chan; Sze, Shirley; Davies, Jim; Tsui, Andrew; Salih, Hizni; Glampson, Ben; Papadimitriou, Dimitri; Mulla, Abdulrahim; Woods, Kerrie; O'Gallagher, Kevin; Shah, Anoop D; Williams, Bryan; Asselbergs, Folkert W; Mayer, Erik; Lee, Richard; Herbert, Christopher; Johnson, Tom; Grant, Stuart; Curzen, Nick; Shah, Ajay M; Perera, Divaka; Patel, Riyaz S; Channon, Keith M; Kaura, Amit; Mayet, Jamil; Eyre, David W; Squire, Iain; Kharbanda, Raj; Lewis, Andrew; Wijesurendra, Rohan S.
Afiliação
  • Chammas L; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • Yuan K; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • Little S; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Roadknight G; NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Varnai KA; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Chang SC; NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Sze S; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Davies J; NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Tsui A; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • Salih H; NIHR Biomedical Cardiovascular Research Centre, Glenfield Hospital, Leicester and the University of Leicester, Leicester, United Kingdom.
  • Glampson B; Department of Computer Science, University of Oxford, Oxford, United Kingdom.
  • Papadimitriou D; Department of Computer Science, University of Oxford, Oxford, United Kingdom.
  • Mulla A; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Woods K; NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • O'Gallagher K; NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Shah AD; NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Williams B; NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Asselbergs FW; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • Mayer E; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Lee R; NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
  • Herbert C; NIHR King's Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, United Kingdom.
  • Johnson T; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Grant S; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Curzen N; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Shah AM; Institute of Health Informatics, University College London, London, United Kingdom.
  • Perera D; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
  • Patel RS; NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Channon KM; NIHR BRC at the Royal Marsden and Institute of Cancer Research, London, United Kingdom.
  • Kaura A; NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, United Kingdom.
  • Mayet J; NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
  • Eyre DW; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom.
  • Squire I; NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
  • Kharbanda R; NIHR King's Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, United Kingdom.
  • Lewis A; NIHR Guys & St Thomas' Hospital Clinical Research Facility, King's College Hospital, and King's College London British Heart Foundation Centre of Excellence, London, United Kingdom.
  • Wijesurendra RS; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Front Cardiovasc Med ; 11: 1406608, 2024.
Article em En | MEDLINE | ID: mdl-38836064
ABSTRACT

Objective:

The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.

Methods:

Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).

Results:

During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.

Conclusions:

The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Front Cardiovasc Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Front Cardiovasc Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido