Recent studies have suggested that during the pandemic, there has been a drop in ST-segment elevation myocardial infarction (STEMI) cases. This has led to fears that patients are not seeking medical attention when they experience symptoms of a STEMI because they are concerned about contracting COVID-19 or being a burden to overstretched hospitals. In this interview, Billal Patel (Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK) speaks about his centre’s experience of the drop in STEMI cases and what they have been doing to encourage STEMI patients to come to hospital.
Have your experienced a drop STEMI cases at your centre?
We have experienced a reduction in cases by about a third at our centre; there seems to a similar trend through the UK and this has been echoed globally. We have also seen that those patients that do present to hospital are, on average, waiting at least twice as long before seeking medical help. This has resulted in more complications from myocardial infarction, including cardiogenic shock, no reflow, left ventricular apical thrombus, and mechanical complications.
Of note, UK data shows emergency admissions of all patients—including cardiac patients—has reduced by 50%. What is worrying is that UK Office for National Statistics (ONS) data suggest a large increase in non-COVID mortality as well.
What do you think is driving these reductions?
Multiple factors may be responsible, including fear of contracting COVID in hospital, not wanting to be a burden on the healthcare system, and cardiac symptoms which patients may attributed to COVID.
What has your centre being doing to encourage people to seek help if they experience STEMI symptoms?
We were concerned with the findings from our centre and our interventional team came up with the idea to run a public awareness campaign. The aim was to reassure patients that we are still treating emergencies and that we have the staff and capacity to treat acute myocardial infarction; we are also reassuring patients that we are have put the necessary precautions in place to prevent them from contracting COVID-19.
At my centre (Lancashire cardiac centre, Blackpool, UK), we have an international team and we have had a successful social media campaign on Facebook, Twitter and YouTube. For example, we have short videos in different languages by our team on the ground: English, Urdu, Pushto, Bengali, Punjabi, Greek, Polish, French, German, Cantonese and Arabic. The local media (BBC North West) has covered our campaign.
Given that the collateral damage from COVID for non-COVID pathology is significant and similar data has been seen from different countries, increasing awareness at the global level is as important as increasing awareness at national and regional levels. Therefore, we wanted to get the message out that the collateral damage is a global problem and, thus, have a global message from a global team.
Additionally, in the UK, we have noticed that people in the black, Asian and minority ethnic (BAME) community seem to have worse outcomes with COVID, and the incidence of cardiovascular disease is also higher than the non-BAME population.
As well as patient concerns, lack of resources may be a reason why centres are performing fewer primary percutaneous coronary intervention (PCI) procedures for STEMI. What is your centre’s experience?
Fortunately, we have been able to continue to provide a 24/7 primary PCI service throughout the pandemic; resources such as personal protection equipment (PPE) have been adequate in the cath lab. We are currently in the process of ensuring each member of the team has their own reusable FFP3 respirator. Sustainability of the rota is another potential risk, but, so far, we have managed well with a team based regional collaborative approach
What has been your experience of treating STEMI patients with COVID-19?
We have performed a number of cases of COVID STEMI. We have found these patients are very sick, often with severely impaired left ventricular function, large thrombus burden, more than one coronary territory affected with worse outcomes. We made a decision a few weeks ago to treat every patient as a potential COVID case given the nature of asymptomatic spread in the community. All of our PPCI cases are performed with Full PPE including FFP3 respirator. So, we have got used to performing all of our interventions with full FFP3 PPE. Once you get you used to “donning and doffing”, it becomes routine. However, the difficulties are that it can be uncomfortable in a long case; you do feel dehydrated and communication can be more challenging. We have found that drilling has been important for the team.