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PubMed: 39401963 DOI: 10.1136/bmjopen-2023-079060
Impact of the COVID-19 pandemic on time to treatment, treatment patterns and outcomes among patients with acute coronary syndrome in Yogyakarta, Indonesia: a retrospective cohort study.
BMJ Open 14(10):e079060
Authors: Pramitha Esha Nirmala Dewi, Sitaporn Youngkong, Montaya Sunantiwat, Surakit Nathisuwan, Montarat Thavorncharoensap
Affiliations
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Abstract
OBJECTIVE
This study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern and treatment outcome.
DESIGN
This is a retrospective cohort study in which medical records of hospitalised patients with ACS were reviewed.
SETTING
Three hospitals in Yogyakarta, Indonesia.
PARTICIPANTS
Patients hospitalised with ACS during two pandemic periods (first pandemic period: March-August 2020; second pandemic period: March-August 2021) and prepandemic period (March-August 2019).
OUTCOME MEASURES
Time to treatment, treatment pattern and treatment outcome.
RESULTS
A total of 598 patients with ST-elevation myocardial infarction (STEMI) and 615 with non-ST-elevation ACS were identified. Of these, 313, 484 and 416 were identified during the prepandemic period, first pandemic period and second pandemic period, respectively. For STEMI, the proportion of patients with a delay from symptom onset to first medical contact (FMC) was significantly higher during the second pandemic period as compared with the prepandemic period (47.7% vs 32.0%, OR=1.84, 95% CI 1.18, 2.85). The proportion of patients with STEMI with delayed door-to-balloon (D2B) time was significantly higher during the second pandemic period as compared with the prepandemic period (99.4% vs 92.9%, OR=13.08, 95% CI 1.57, 108.73). Significantly longer mean total ischaemic time (45.85 hours vs 30.29 hours, mean difference=14.56, 95% CI 1.85, 27.28) was observed among patients with STEMI during the second year of the pandemic as compared with the prepandemic period. No significant differences between the prepandemic period and the first pandemic period were found in terms of proportion of patients with STEMI with a delay in time from symptom onset to FMC, delayed D2B time and total ischaemic time. Only Global Registry of Acute Coronary Events risk score (OR=1.04, 95% CI 1.03, 1.05) was a significant predictor of in-hospital mortality in the multivariate analysis.
CONCLUSIONS
This study suggests a significant impact of the COVID-19 pandemic on time to treatment among patients with ACS. Health systems need to be well prepared to support effective and timely treatment of patients with ACS during future crisis.
MeSH
Treatment Outcome, Cohort Studies, Hospital Mortality, Acute Coronary Syndrome, Public Health, Respect, St Elevation Myocardial Infarction, Covid-19, Coronary Disease, Pandemics, Time-To-Treatment, Therapeutics