Impact of the COVID-19 lockdown on ischaemic heart disease: before-and-after observational study

Abstract

Background: The onset of the COVID-19 pandemic had a huge impact on our society, even the healthcare system had to adapt to the new circumstances. The online access to healthcare centres became easier, but the barriers between physicians and patients were multiplied. Many interventions and consultations were delayed for many months with the purpose of reducing the contagion. Nevertheless, some pathologies cannot be postponed, they must be diagnosed and treated immediately. One of them is heart ischaemic disease, which is the main cause of mortality worldwide. Different studies around the globe have already shown a change in its tendencies: decrease in hospital admissions, increase in mortality, and treatment delay, among others. It is known that we will keep having outbreaks until a treatment or a vaccine are found, so we might end up in a similar situation very soon. Knowing exactly which procedures were altered during the National quarantine in our environment is the first step to prevent them from malfunctioning again in the next lockdown. Objectives: The main objective is to determine whether there is an increase in time-to-reperfusion of STEMI during and after the COVID-19 lockdown compared to the same periods in the previous year in Girona. The secondary objective is to determine whether there is a decrease in the accumulated incidence of STEMI during and after the COVID-19 lockdown compared to the same periods in the previous year in Girona.

Methodology: It is a before-and-after observational study using a population- based AMI registry, the registre Codi IAM. We will compare time-to-reperfusion,

incidence and mortality in Girona between the COVID-19 lockdown, the following period until the next outbreak, and the same periods the year before by the

corresponding analysis of variance, Poisson regression and Cox Proportional- Hazard. The 3 analysis will be stratified by covariates.

Participants: All the STEMI occurred in Girona and treated in the Hospital Dr Josep Trueta during the 4 periods