DÄ internationalArchive35-36/2020Acute Myocardial Infarction Admissions in Berlin During the COVID-19 Pandemic

Correspondence

Acute Myocardial Infarction Admissions in Berlin During the COVID-19 Pandemic

Dtsch Arztebl Int 2020; 117: 597-8. DOI: 10.3238/arztebl.2020.0597

Dreger, H; Bruch, L; Maier, B; Schühlen, H

LNSLNS

Since the first cases were reported from Wuhan, China, at the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide in only a few months and has resulted in substantial morbidity and burdens on regional healthcare institutions, as well as prompted restrictions on public life. Especially the more severely affected regions, such as northern Italy and the USA, have in parallel reported reduced hospital admissions of patients with acute myocardial infraction (1–4).

To analyze a possible effect of the pandemic on the care of patients with myocardial infarction in Berlin, we determined all inpatient admissions with a main diagnosis of acute myocardial infarction (ICD-10 I21) and numbers of percutaneous coronary interventions (PCI) in infarct patients (I21 with OPS [the German coding system for operations and procedures] 8–827) from the hospital sites of Charité—Universitätsmedizin Berlin, Vivantes Hospital Group, and Unfallkrankenhaus Berlin, with admission dates in calendar weeks 2–21 of the years 2017 to 2020. The three institutions provide healthcare to about two-thirds of Berlin’s patients with myocardial infarction.

In parallel to the rising numbers of COVID-19 cases (5) and the imposed restrictions on public life, a moderate reduction in inpatient admissions of patients with acute myocardial infarction was seen in Berlin too, compared with the same time period in the three previous years (Figure). Numbers of PCI in such patients also fell during calendar weeks 11–14. This was particularly driven by a significant reduction of PCI in patients with non–ST-elevation myocardial infarction (NSTEMI) (Table). In the following weeks up to calendar week 21, inpatient admissions for myocardial infarction reached the level of previous years; in parallel, the number of notifications of COVID-19 cases clearly declined.

COVID-19 incidence in Berlin and inpatient admissions for myocardial infarction in calendar weeks (CW) 2 to 21 in 2020 as well as 2017–2019 (median ± minimum and maximum values). AMI, acute myocardial infarction
Figure
COVID-19 incidence in Berlin and inpatient admissions for myocardial infarction in calendar weeks (CW) 2 to 21 in 2020 as well as 2017–2019 (median ± minimum and maximum values). AMI, acute myocardial infarction
Percutaneous coronary interventions (OPS 8–837) in all patients with myocardial infarction (I21) and in patients with STelevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) in calendar weeks 11–14 in 2017–2019 compared with 2020
Table
Percutaneous coronary interventions (OPS 8–837) in all patients with myocardial infarction (I21) and in patients with STelevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) in calendar weeks 11–14 in 2017–2019 compared with 2020

Definitive conclusions relating to the possible causes can currently not be drawn. Further to random fluctuations or the possibility of a lower incidence of infarctions—for example, as a result of reduced physical activity—what is being discussed primarily is a reduced use of healthcare services by patients because of fear of nosocomial infection with SARS-CoV-2 (2, 3).

Our data suggest that the fall in inpatient admissions for myocardial infarctions that was observed in regions severely affected by COVID-19 was also observed—albeit to a lesser degree—in less affected regions, such as Berlin, where sufficient resources continued to be available to provide unrestricted medical care.

In order to prevent cardiovascular deaths as a result of lacking or delayed activation of the emergency medical services, it is of crucial importance to communicate to the public that symptoms of myocardial infarction should be taken seriously and investigated without delay, even during a pandemic.

Henryk Dreger, Leonhard Bruch, Birga Maier, Helmut Schühlen

Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie (CCM), Charité—Universitätsmedizin Berlin (Dreger), henryk.dreger@charite.de

Berlin-Brandenburger Herzinfarktregister (B2HIR)
(Dreger, Bruch, Maier, Schühlen)

BG Klinikum Unfallkrankenhaus Berlin gGmbH (Bruch)

Vivantes Netzwerk für Gesundheit GmbH Berlin (Schühlen)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 9 May 2020, revised version accepted on
30 July 2020.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Dreger H, Bruch L, Maier B, Schühlen H:
Acute myocardial infarction admissions
in Berlin during the COVID-19 pandemic

Dtsch Arztebl Int 2020; 117: 597–8.
DOI: 10.3238/arztebl.2020.0597

1.
De Filippo O, D‘Ascenzo F, Angelini F, et al.: Reduced rate of hospital admissions for ACS during covid-19 outbreak in Northern Italy. N Engl J Med 2020; 383: 88–9 CrossRef MEDLINEPubMed Central
2.
Garcia S, Albaghdadi MS, Meraj PM, et al.: Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol 2020; 75: 2871–2 CrossRef MEDLINE PubMed Central
3.
Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ: Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J 2020, 41: 1852–3 CrossRef MEDLINE PubMed Central
4.
Rodriguez-Leor O, Cid-Alvarez B, Ojeda S, et al.: Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. REC Interv Cardiol 2020; 2: 82–9 CrossRef
5.
Robert-Koch-Institut: COVID-19-Dashboard. https://corona.rki.de (last accessed on 27 July 2020)
COVID-19 incidence in Berlin and inpatient admissions for myocardial infarction in calendar weeks (CW) 2 to 21 in 2020 as well as 2017–2019 (median ± minimum and maximum values). AMI, acute myocardial infarction
Figure
COVID-19 incidence in Berlin and inpatient admissions for myocardial infarction in calendar weeks (CW) 2 to 21 in 2020 as well as 2017–2019 (median ± minimum and maximum values). AMI, acute myocardial infarction
Percutaneous coronary interventions (OPS 8–837) in all patients with myocardial infarction (I21) and in patients with STelevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) in calendar weeks 11–14 in 2017–2019 compared with 2020
Table
Percutaneous coronary interventions (OPS 8–837) in all patients with myocardial infarction (I21) and in patients with STelevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) in calendar weeks 11–14 in 2017–2019 compared with 2020
1.De Filippo O, D‘Ascenzo F, Angelini F, et al.: Reduced rate of hospital admissions for ACS during covid-19 outbreak in Northern Italy. N Engl J Med 2020; 383: 88–9 CrossRef MEDLINEPubMed Central
2.Garcia S, Albaghdadi MS, Meraj PM, et al.: Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol 2020; 75: 2871–2 CrossRef MEDLINE PubMed Central
3.Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ: Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J 2020, 41: 1852–3 CrossRef MEDLINE PubMed Central
4.Rodriguez-Leor O, Cid-Alvarez B, Ojeda S, et al.: Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. REC Interv Cardiol 2020; 2: 82–9 CrossRef
5.Robert-Koch-Institut: COVID-19-Dashboard. https://corona.rki.de (last accessed on 27 July 2020)