Impact of COVID-19 pandemic early response measures on myocardial infarctions and acute cardiac care in Singapore.
Int J Qual Health Care 2023:7156526. [PMID:
37148306 DOI:
10.1093/intqhc/mzad023]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/03/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND
The COVID-19 pandemic impacted acute myocardial infarction (AMI) attendances, ST-elevation myocardial infarction (STEMI) treatment and outcomes. We collated data from majority of primary percutaneous coronary intervention (PPCI)-capable public healthcare centres in Singapore to understand the initial impact COVID-19 had on essential time-critical emergency services. We present data comparisons from 'Before Disease Outbreak Response System Condition (DORSCON) Orange', 'DORSCON Orange to start of circuit breaker (CB)' and during the first month of 'CB'.
METHODS
We collected aggregate numbers of weekly elective PCI from 4 centres and AMI admissions, PPCI and in-hospital mortality from 5 centres. Exact door-to-balloon (DTB) times were recorded for 1 centre; another 2 reported proportions of DTB times exceeding targets.
RESULTS
Median weekly elective PCI cases significantly decreased from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (34 vs. 22.5, p=0.013).Median weekly STEMI admissions and PPCI did not change significantly. In contrast, the median weekly NSTEMI admissions decreased significantly from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (59 vs. 48, p=0.005) and was sustained during CB (39 cases).Exact DTB times reported by 1 centre showed no significant change in the median. Out of 3 centres, 2 reported significant increases in the proportion that exceeded DTB targets.In-hospital mortality rates remained static.
CONCLUSION
In Singapore, STEMI and PPCI rates remained stable, while NSTEMI rates decreased during DORSCON and CB. The SARS experience may have helped prepare us to maintain essential services such as PPCI during periods of acute healthcare resource strain. However, data must be monitored and increased pandemic preparedness measures must be explored to ensure that AMI care is not adversely affected by continued COVID fluctuations and future pandemics.
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