| Abstract |
COVID – 19 pandemic caused significant functional changes in the health care systems, the limited patients’ appearance in health structures being the reasonable outcome. Several theories have been developed to explain this phenomenon with the most plausible ones to be the voluntary distance of patients due to either psychological motives or limited information, as well as due to delays in service in emergency situations.
In this study a multicentric cohort analysis has been performed in hospitals of the island of Crete, in Greece. The purpose of the study was to investigate the effects of lockdown on the treatment of ACS. To this extend two parameters have been studied. 1. The quantitative measurement of patients’ check – in in the cardiologic clinics of Heraklion, Crete and the comparative analysis of data before and after the pandemic. 2. The comparative analysis of STEMI and NSTEMI in the pre and post periods and their relation with total ACS hospitalization. The 7,074 people, who were found in the register of the participating clinics, constitute the study population. Additionally, the sample consists of 989 individuals who were diagnosed with acute coronary syndrome.
Data was selected from two hospitals of the island, the university hospital and the peripheral hospital. Three time periods were analyzed of the consecutive years 2019, 2020 and 2021. The data of the 2019 period represented the pre- COVID period, 2020 sixmester presented the first pandemic wave, and 2021 data presented the second and third waves. Statistical analysis of data was performed and grouped in corresponding monthly periods, and averages were calculated per annual or monthly basis. Comparison tables were generated. The difference control for more than 2 groups was conducted with one-way ANOVA. The programme used to display the results is IBM SPSS Statistics 24.0.
The results show that remarkable decrease has been observed for ACS (6,1%) (p,0,001%)during the three - year study. Specifically for non-ST-segment elevation myocardial infractions (NSTEMI) statistically significant reductions occurred from 2019 (59,1% vs 53,7% for 2020 and 53,8% for 2021), whereas ST-segment elevation myocardial infractions (STEMI) cases showed an increase in annual average rates, which translates from 23,4%(2019) for 33,1%(2020) and 32,7%(2021). Respectively, in the cases of unstable angina observed a reduction of cases from 17,5% vs 13,2% vs 13,5% for 2019,2020 and 2021 (p=0,012).
Demographic characteristics such as gender and age, when analysed, show higher rates of hospitalization for ACS Syndromes (73,5%) compared to the rest of diagnoses (66,5%) for males. Men were also found to have statistically higher rates of STEMI compared to women (77,5%vs 22,5%). Similarly, the 61-70 age group was diagnosed with a higher incidence of acute coronary syndromes (26,3%) than different diagnoses (22%).51-60 years age group shows a statistically significant difference in the incidence of STEMI (26,8%) (p:0,040).Similarly, the age group of 61-70 years, was found the group with the higher difference in the diagnosis of NSTEMI between the other types of ACS Syndromes.
The analysis of social characteristics, such as insurance, indicated the uninsured persons treated for ACS are statistically more than those with other diagnoses. The monthly distribution observed larger reductions in the incidence of ACS Syndromes during the pandemic period, with a rate of the decrease to reach the -0,0031 per month. In the case of STEMI, the decrease does not reach statistically significant levels and the rate of change per observed month is -0,012.
It is expected that patients that have not received appropriate treatment during the pandemic to present complications and increase the hospitalization frequency, due to arrhythmias, new cardiac episodes and increased rates of cardiac failures. Health systems must be properly prepared in the aftermath, but also in subsequent pandemics, to respond to the increasing demand for timely and urgent intervention in cases where the outcome of the disease is directly linked to timely treatment.
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