The course of Acute Myocardial Infarction during the COVID-19 lock down in high and low endemic COVID-19 regions in the Netherlands

Background At the time of the first COVID-19 outbreak in the Netherlands, there was a fear that this could jeopardize acute heart attack care in the Netherlands. In the case of an acute heart attack, it is important to keep the time loss between the onset of symptoms and treatment (opening the artery to the heart by angioplasty) as short as possible. Time loss can be caused by various factors. For example: the patient does not dare to sound the alarm for fear of infection in the hospital, the ambulance is too busy transporting COVID patients. In this study, we have mapped out the time factors. Objective The aim of this study is to investigate whether patients with an acute heart attack in the COVID-19 period waited longer to seek medical help or whether medical help took longer to arrive and what the consequences are. Study design This is a retrospective cohort study into the effect of the COVID-19 outbreak on both patient and system delay and the prevention of cardiovascular complications and mortality of acute heart attacks in the Netherlands. These results were compared with the results of 2019 and regional differences between the Northern Netherlands (low endemic area) and North Brabant (high endemic area) were mapped. First results This study shows that treatment delay in patients with ST-elevation myocardial infarction (STEMI) increased during the COVID-19 outbreak. This became visible when patients during the COVID-19 outbreak were compared with patients from 2019 (before the outbreak). The same difference was also found when patients from a high endemic COVID-19 area (North Brabant) were compared with patients from a low endemic COVID-19 area (North Netherlands). The increase was caused by a longer patient delay (when patients wait longer to seek medical help). The system delay remained stable. This means that the STEMI care network continued to function well during the COVID-19 outbreak. The study also shows that mortality and complications in STEMI patients did not increase during the COVID-19 outbreak. Since STEMI patients benefit from a short treatment delay, patients should be encouraged to continue reporting acute cardiac complaints. Even in times of crisis.