Heart Attack During COVID Lockdowns Linked to Shorter Life Expectancy

Williams Wijns, MD, PhD
Credit: Twitter

A new study from investigators in Europe warns patients who experienced heart attacks during the first COVID-19 lockdowns in the UK and Spain could expect to live 1.5-2 years less than their pre-COVID counterparts.

Results of the study, which used a Markov decision-analytic model to assess the probability of outcomes, suggest hospitalization with ST-elevated myocardial infarction (STEMI) during a lockdown period was associated with a reduction in survival and quality-adjusted life-years (QALYs) compared to hospitalization for STEMI during pre-pandemic periods.¹

“Restrictions to treatment of life-threatening conditions have immediate and long-term negative consequences for individuals and society as a whole,” said study investigator William Wijns, MD, PhD of the Lambe Institute for Translational Medicine, University of Galway, Ireland.² “Back-up plans must be in place so that emergency services can be retained even during natural or health catastrophes.”

Now, more than 3 years after the start of the COVID-19 pandemic, investigators are just beginning to uncover and unravel years of data. An example of this is a data release from the American Heart Association in January 2023. In the organization’s 2023 Statistical Update, the American Heart Association released data detailing an increased rate of cardiovascular disease-related deaths during the first year of the COVID-19 pandemic in the US. According to the AHA, cardiovascular disease-related deaths surged for 874,612 in 2019 to 928,741 in 2020, which is the largest single-year increase since 2015 and the greatest total recorded since 910,000 deaths in 2003.³

Among the chief concerns cited by cardiologists and cardiology care professionals in the early portions of the pandemic was ante reduction in patients presenting to the hospital and emergency departments with myocardial infarction. A study in England found the admission rates for acute coronary syndromes in England were approximately 40% lower than prepandemic periods.⁴

In the current study, Wijns and a team of investigators sought to examine the consequences of untimely or missed revascularization of STEMI patients during the COVID-19 pandemic, with a specific interest in predicting the long-term health outcomes and cost of reduced treatment of STEMIs during the COVID-19 lockdowns in the UK and Spain.¹

Investigators used a Markov decision-analytic model to calculate survival and QALYs as well costs of reduced treatment. Investigators pointed out these models included data related to probability of hospitalization, and timeliness of percutaneous coronary intervention in calculations. For the purpose of analysis, the UK model compared STEMIs occurring from March 23-April 22, 2020 to those occurring during the equivalent time in 2019. The Spanish model compared March 2020 to March 2019. Investigators pointed out their survival projections considered age, hospitalization status, and time to treatment using published data for each country.¹

Upon analysis, results indicated STEMI patients from the first UK lockdown were expected to lose a mean of 1.55 life-years and 1.17 QALYs compared to their counterparts who presented with STEMI during a prepandemic period. Investigators pointed out this correlated to an increase of €41.3 million ($44.3 million) in total additional lifetime costs. Results indicated STEMI patients from the first SPANISH lockdown were expected to lose 2.03 life-years and 1.63 QALYs compared to their counterparts who presented during the prepandemic period. Investigators pointed out this correlated to an increase of €88.6 million ($95.12 million) in total additional lifetime costs. Investigators pointed out work absenteeism was the main contributor to costs among, but also noted part of this cost was offset by lower costs of heart failure hospitalizations as more STEMI patients died during lockdown.¹

“The findings illustrate the repercussions of delayed or missed care. Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come,” Wijns added.² “Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay. Public awareness campaigns should emphasize the benefits of timely care, even during a pandemic or other crisis.”

References:

1. Lunardi M, Mamas MA, Mauri J, et al. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries [published online ahead of print, 2023 Jun 7]. Eur Heart J Qual Care Clin Outcomes. 2023;qcad025. doi:10.1093/ehjqcco/qcad025
2. One-month of COVID-19 lockdown cost heart attack patients up to two years of life. European Society of Cardiology. June 7, 2023. Accessed June 8, 2023. https://www.escardio.org/The-ESC/Press-Office/Press-releases/One-month-of-COVID-19-lockdown-cost-heart-attack-patients-up-to-two-years-of-life.
3. Iapoce C. CVD-related deaths surged during first year of COVID-19 pandemic. HCP Live. January 30, 2023. Accessed June 8, 2023. https://www.hcplive.com/view/cvd-related-deaths-surged-during-first-year-covid-19-pandemic.
4. Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-389. doi:10.1016/S0140-6736(20)31356-8