COVID-19 lockdown impact on quality of treatment and outcomes of STEMI and stroke patients in a large tertiary medical center: an observational study

Abstract

Background: The coronavirus 2019 (COVID-19) pandemic affected health-care systems worldwide, leading to fewer admissions and raising concerns about the quality of care. The objective of this study was to investigate the early effects of the COVID-19 pandemic on quality of care among stroke and ST-elevation myocardial infarction (STEMI) patients, focusing on clinical outcomes and direct treatment costs.

Method: This retrospective, observational study was based on the 10-week period that included the first wave of the COVID-19 pandemic in Israel (15 February 2020-30 April 2020). Emergency department admissions for stroke and STEMI were compared with parallel periods in 2017-2019, focusing on demographics, risk and severity scores, and the effect of clinical outcomes on hospitalization costs.

Results: The 634 stroke and 186 STEMI cases comprised 16% and 19% fewer admissions, respectively, compared to 2019. No significant changes were detected in demographics, most disease management parameters, readmission and mortality outcomes. The mean door-to-balloon time increased insignificantly by 33%, lowering the health quality indicator (HQI) for treatment in <90 min from 94.7% in 2017-2019 to 83% in 2020 (P = 0.022). Among suspected stroke patients, 97.2% underwent imaging, with 28% longer median time from admission (P = 0.05). Consequently, only 24.3% met the HQI of imaging in <29 min, compared to 45.5% in 2017-2019 (P < 0.01). Increased length of stay and more intensive care unit admissions were the leading causes of 6.5% increased mean cost of STEMI patients' initial hospitalization, which totaled $29 300 in the COVID-19 period (P = 0.008).

Conclusion: The initial pandemic period caused a decline in HQIs linked to diagnostic and treatment protocols, without changes in outcomes, but with increased hospitalization costs. Medical information and awareness of life-threatening conditions among patients and caregivers should be increased to enable proper diagnosis and management.

Keywords: COVID-19; acute ST-elevation myocardial infarction (STEMI); cerebrovascular accident (CVA); clinical outcomes; health quality indicators (HQIs); stroke.