Impact of COVID-19 on NSTEMI Patients in VA Hospitals

This study looks at how the COVID-19 pandemic affected patients with heart issues, specifically those diagnosed with Non-ST-Elevation Myocardial Infarction (NSTEMI) in VA hospitals. The focus is on how many patients presented with NSTEMI during different stages of the pandemic, what treatments they received, and how their health outcomes varied.

#Background

When COVID-19 began spreading in early 2020, VA hospitals were instructed to postpone many non-emergency Procedures, including those for heart issues. Only urgent cases were allowed. This meant that many patients with NSTEMI, a serious condition that can lead to heart attacks, could not get the timely care they needed. The pandemic created an unusual situation that helped researchers learn about how treatment and outcomes changed over this time.

#Patient Selection

The researchers looked at all patients diagnosed with NSTEMI in VA hospitals from January 1, 2019, to October 30, 2022. They included a large number of patients, with over 67,000 diagnosed within that time, and focused on the 27,346 who received care at hospitals equipped to perform critical heart procedures.

#Phases of COVID-19

The study divided the pandemic into six phases to understand how heart treatment and patient health were affected over time:

1. Pre-COVID Phase: From January 1, 2019, to February 15, 2020, before the pandemic began.

2. Phase 1 (Acute Phase): From February 16 to April 15, 2020, when NSTEMI cases began to drop sharply due to COVID-19 and when many elective procedures were postponed.

3. Phase 2 (Community Spread): From April 16 to October 27, 2020, marked by increased COVID-19 infections across the country.

4. Phase 3 (First Peak): From October 28, 2020, to February 20, 2021, this period saw the highest rates of COVID-19 infections.

5. Phase 4 (Post-Vaccine): From February 21, 2021, to December 10, 2021, after vaccinations were widely available.

6. Phase 5 (Second Peak): From December 11, 2021, to February 15, 2022, another spike in COVID-19 cases occurred.

7. Phase 6 (Recovery Phase): From February 16 to October 30, 2022, when most COVID-19 restrictions were lifted.

#Findings on NSTEMI Cases

#NSTEMI Incidence

During the first phase of the pandemic, the number of NSTEMI cases dropped significantly. April 2020 saw only 486 cases, which was about 63% less than the peak from January 2020. In the following phases, while there was some recovery, the number of cases did not return to pre-pandemic levels.

#Treatment Procedures

The number of procedures to diagnose and treat NSTEMI (like angiograms and heart surgeries) also fell during Phase 1. In April 2020, only 244 procedures were performed, which was 58.7% of what was done in January 2020. However, by looking at all phases, there was no significant difference in the overall chance of receiving a procedure related to NSTEMI between pre-COVID and the later phases.

#Mortality Rates

Mortality rates for NSTEMI patients were higher in Phase 2, Phase 3, and Phase 5 compared to the period before the pandemic. In initial analyses, patients in these phases had greater chances of dying within 30 days of being diagnosed, even after considering factors like age, existing health conditions, and whether they tested positive for COVID-19.

In contrast, during Phase 6, mortality rates dropped below pre-pandemic levels, suggesting that by this time, patients were receiving better care.

#Comparison between VA and Non-VA Facilities

Many veterans sought care at non-VA hospitals during the pandemic. On average, non-VA patients had a higher risk of death compared to those treated within the VA system during most phases. After adjusting for different patient characteristics, the higher mortality rate at non-VA facilities was significant mainly in Phases 3, 4, and 6.

#Implications of the Findings

The study highlights some important points:

1. Vaccine Impact: Despite the availability of vaccines, the number of patients presenting with NSTEMI did not significantly improve. This indicates that the pandemic may have changed how patients seek care, with many likely staying home due to fear of COVID-19 even if they had symptoms.

2. Vulnerability During Peaks: Higher mortality during the second and third phases of the pandemic shows that these times created vulnerabilities for patients with heart issues. It indicates that the healthcare system struggled during these critical periods.

3. Access To Care: The decline in NSTEMI presentations among rural and less-educated patients during the pandemic showed that existing barriers to healthcare access became worse.

4. Procedural Care: The study found that the decreased procedure rates did not contribute to higher mortality, suggesting that even though fewer procedures were done, the care that was provided was adequate for the patients who received it.

#Limitations of the Study

This study does have some limitations. While the coding for NSTEMI diagnoses is generally reliable, the accuracy of recording other heart-related issues during the pandemic might not be perfect. The study's population is mostly men, which could result in different outcomes compared to the general public. Lastly, the researchers could only analyze data from those who sought medical attention, meaning they missed patients who did not go to the hospital.

#Conclusion

In summary, the study examined how the COVID-19 pandemic affected heart attack patients in VA hospitals. The findings showed a drop in both NSTEMI cases and related procedures during the early pandemic phases, with increased mortality during specific periods. As the healthcare system adapted over time, the outcomes seemed to improve in later phases. These results contribute to our understanding of how a large-scale public health crisis can impact not only the immediate treatment of patients but also the overall trends in healthcare access and outcomes.