May 31 2020
European Heart Journal published an article by a group of Italian authors titled Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era.
The results are identical to the ones recently published by Kaiser Permanente in California - 48% reduction in admissions for acute myocardial infarction (AMI). See my post May 19 Infarction Infarcted - Miracle Working Virus.
The Italian authors went a few steps further and looked at the outcomes, complications, and accounted for SARS-CoV-2 positive patients with AMI.
A total of 319 AMIs were registered during the 2020 week, with a 48.4% reduction compared with the equivalent week in 2019, when 618 patients were hospitalized for the same diagnosis;
The drop was more significant in so-called NON-STEMI myocardial infarction (without certain changes on EKG - ST elevation, and, typically, with better prognosis) - 65.1% vs. STEMI myocardial infarction (with ST elevation on EKG) - 25.5%;
Case fatality rates roughly tripled:
2.8% to 9.7% overall;
4.1% vs. 13.7% in STEMI AMI, and
1.7% to 3.3% in NON-STEMI AMI.
Major complication rates roughly doubled:
7.4% to 15.7% overall;
10.4% vs. 18.8% in STEMI AMI, and
5.1% to 10.7% in NON-STEMI AMI.
Amongst STEMI patients 10.7% were SARS-CoV-2 positive with case fatality rate of 28.6%;
A similar reduction in hospitalizations was also registered in:
Heart failure - 46.8%;
Atrial fibrillation - 53.4%;
Failure of the implantable defibrillator - 29.4%;
Pulmonary embolism - 63.2%.
The time from symptoms onset to coronary angiography increased by 39.2%;
The time from the first medical contact to coronary revascularization increased by 31.5%;
Despite the fact that time course of the COVID-19 outbreak was not synchronous across Italy, a similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%);
The main limitation of the study is that we do not know what happened to patients with AMI who did not reach the hospital. Amongst possible scenarios are:
Patient was able to “tough it out” and recover;
Patient did reach hospital, but was misdiagnosed as COVID-19;
Patient died before or right after reaching a hospital and before diagnosis could be established.
The bottom line: politicians and administrators obsession with the virus results in doubling/tripping negative outcomes. This is called collateral damage in times of war, but I can only call it two things: stupidity or criminal neglect.