What are the potential long-term effects on healthcare and the economy due to decreased STEMI treatment during the COVID-19 pandemic?

In a recent study published in the European Heart Journal – Quality of Care and Clinical Outcomes, researchers predicted long-term health consequences and expenses associated with ST-elevation myocardial infarction (STEMI) treatment during the first coronavirus disease 2019 (COVID-19) lockdown.

Background

The global healthcare systems were significantly affected by the COVID-19 pandemic. The pandemic has decreased access to cardiovascular care, resulting in adverse outcomes, despite measures to maintain the systems. During the first wave of the pandemic, there was a significant decrease in hospital admissions for STEMI, with some areas experiencing a reduction of over 50%.

The present study assessed the potential long-term effects on healthcare and the economy due to decreased STEMI treatment during the COVID-19 pandemic.

About the study

A model was created to predict the survival, quality of life (QoL), and cost outcomes for patients with STEMI during the first wave of COVID-19 infections in the UK and Spain. The study compared patients who had STEMI before and during the pandemic. The analysis concentrated on the outcomes during the first COVID-19 wave's peak, where hospitalization rates decreased.

Survival projections were performed based on patient age, the status of hospitalization, and time to treatment via country-specific life tables and research on STEMI patient survival outcomes. Both short-term and long-term projections were considered.

The cost analysis primarily examined the expenses related to the initial hospital admission and treatment, follow-up treatment, and heart failure management, considering recommendations for assessing societal implications. The analysis model employed a lifetime horizon and calculated life-years, costs, and quality-adjusted life-years (QALYs) for each group according to monthly cycles.

The study analyzed the projected outcomes for a group of STEMI patients before the COVID-19 pandemic and compared them to a similar group during the first wave of the pandemic. The UK analysis was conducted one month after the first national lockdown that started on March 23, 2020. The model was divided into short-term and long-term components.

The model's short-term component computed results for each group up to 30 days after STEMI. The study followed patients through a short-term period and then used a long-term model to predict their lifetime survival outcomes. The study also involved hospitalized patients categorized into two groups: those who underwent percutaneous coronary intervention (PCI) and those who received conservative management.

Results

During the first month of the COVID-19 pandemic, STEMI patients were estimated to experience a loss of 1.55 life-years compared to those who had a STEMI before the pandemic. This also decreased projected QALYs over a lifetime horizon, with a reduction of 1.17 QALYs. From the National Health Service (NHS) perspective, the costs were expected to be comparable in both groups, with an increase of £214 during the pandemic. However, when considering all work absenteeism costs and all payer-borne costs, the 'pandemic' group had significantly higher costs of nearly £9000 per patient from a broader societal perspective.

During the UK lockdown, reduced PCI access resulted in a loss of 6,367 life-years for patients with a STEMI during the first month, based on a yearly STEMI incidence of 49,332 cases. The additional lifetime costs were £36.6 million at a population level, and 4794 QALYs were lost over the patients' lifetime. The main expenses in both groups are attributed to work absenteeism and hospital admissions related to heart failure, with the pandemic group incurring higher costs for work absenteeism. On the other hand, the costs associated with PCI are relatively minor.

During the initial month of the first wave of the pandemic, Spanish STEMI patients were estimated to experience a loss of 2.03 life-years compared to those who had a STEMI before the pandemic, with a corresponding decrease in projected QALYs over their lifetime. The pandemic group incurred higher expenses from a societal perspective, although costs were comparable from a payer perspective. The projected expenses for the rest of the patients' lives amounted to €88.6 million, resulting in a loss of 7215 QALYs.

Conclusion

A one-month COVID-19 lockdown negatively impacted STEMI treatment, resulting in decreased survival rates and QALYs compared to the time before the pandemic. Untimely revascularization in working-age patients has been found to have a negative impact on their prognosis, resulting in reduced societal productivity and increased societal costs.

The study indicates that the main factors affecting survival and economic disparities during the pandemic were the decrease in hospitalization rate and timely PCI rate, suggesting that not receiving treatment within the appropriate time frame is the primary factor contributing to negative clinical outcomes and associated expenses.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.