Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention Volume—An Australian Perspective - 02/07/24

Doi : 10.1016/j.hlc.2024.02.018

Kawa Haji, MBBS, PhD ^a,^b,^c, Sara Vogrin, MBBS, MBiostat ^c, Nicholas D’Elia, BMSci, MBBS ^a,^b, Samer Noaman, MBChB ^a,^d, Jason E. Bloom, MBBS ^b,^d, Jeffrey Lefkovits, MBBS ^e, Chris Reid, PhD ^e, Angela Brennan ^e, Diem T. Dinh, PhD ^e, Stephen Nicholls, MBBS, PhD ^f, Emily Nehme, MBiostat ^e,^g, Ziad Nehme, PhD ^e,^g, Karen Smith, PhD ^e, Dion Stub, MBBS, PhD ^a,^b,^d,^g, Jocasta Ball, PhD ^g, Sarah Zaman, MBBS, PhD ^h,ⁱ, Ernesto Oqueli, MD ^j,^k, David Kaye, MBBS, PhD ^b,^d, Nicholas Cox, MBBS ^a,^c, William Chan, MBBS, PhD ^a,^b,^c,^d,^⁎
^a Department of Cardiology, Western Health, Vic, Australia
^b Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
^c Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
^d Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
^e School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
^f Victorian Heart Institute and Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
^g Ambulance Victoria, Melbourne, Vic, Australia
^h Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
ⁱ Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
^j Department of Cardiology, Ballarat Health, Ballarat, Vic, Australia
^k Deakin University, School of Medicine, Geelong, Vic, Australia

^∗Corresponding author at: Department of Cardiology, Sunshine Hospital, Western Health, Furlong Rd, St Albans VIC 3021, AustraliaDepartment of CardiologySunshine HospitalWestern HealthFurlong Rd, StAlbansVIC3021Australia

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Abstract

Background

Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described.

Method

We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020–12 May 2020); pre-lockdown (26 Feb 2020–25 Mar 2020); post-lockdown (13 May 2020–10 Jul 2020); and the year prior (26 Mar 2019–12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods.

Results

The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33–0.93]; p=0.026); post-lockdown (OR 0.66; [0.40–1.06]; p=0.087); and the year prior (OR 0.55 [0.33–0.93]; p=0.026).

Conclusions

Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.

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Keywords : PCI, COVID-19, Emergency medical services, Lockdown