Evaluation of impact of COVİD-19 pandemic on admission rates and management of acute coronary sendromes in emergency department

Introduction and Aim: The SARS-Cov-2 virus has caused a pandemic by infecting approximately 620 million people all over the world so far by causing the COVİD-19 disease. There have been serious changes in the health care system during the pandemic process, and a decrease in the number of hospital admissions has been observed with the restrictions. Although a decrease is observed in the number of acute coronary sendroms, changes in the approach have also changed. İn our study, we investigated the effects of the pandemic period on the amount, admission method and management of patients who applied to the emergency department of our hospital with Acute coronary sendrome. Methods: Our research was carried out retrospectively between 10.03.2019 and 10.03.2021, at Emergency Department of Bezmialem Vakif University Medicine Hospital. In our study, 1297 patients were screened who applied to our emergency department and were diagnosed with ACS in a total of two years. The data of the patients were analyzed in two groups as pre-pandemic (pre-P) (10.03.2019-10.03.2020) and post-pandemic (post-P) (10.03.2020-10.03.2021). The demographic characteristics of the patients, their diagnoses,differences of admissions, chronic diseases, treatment and outcome patterns were checked and recorded in the form we prepared. Then the collected data were compared as pre-P and post-P. Statistical significance was determined as p<0.05 for all cases. Statistical analysis was performed using the IBM SPSS for Windows v.22 (IBM, Armonk, NY, United States) statistical package. Results: The study was initiated with 1962 patients whose AMI diagnoses code was entered in the emergency medicine department for two years. 101 patients with missing data, and 201 patients who were discharged from emergency department after the diagnoses of AMI was excluded by the emergency physician or cardiologist, and 363 patients who were admitted to the coronary intensive care unit or cardiology department with other diagnoses were excluded from the study. Continued with 1297 patients with definite diagnosis of ACS. The cases were separated into two as pre-P and post-P. While the number of applictions was 703 in the pre-P period, it was 594 in the post-P. While the average number of monthly applications was 59 in the pre-P period, the average number of monthly applications in the post-P period calculated as 50. When demographic caractheristics were analyzed in the pre-P period 488 (69.4%) of 703 patients were male and 215 (30.6%) were female, in the post-P period 410 (69.0%) of 594 patients were male and 184 (31.0%) were female. The mean age was 57.1± 13.2 years. While the number of STEMI was 242 (34.4%) and NSTEMI 461 (65.6%) in the pre-P period, STEMI was 225 (37.9%) and NSTEMI 369 (62.1%) in the post-P period. While the number of outpatient admissions was 602 (85.6%) in the pre-P period, it decreases to 474 (79.8%) in the post-P period, and a statistically significant difference was found (p<0.05). While the number of referral from another center was 38 (%5.4) in the pre-P period, it increased to 57 (9.6%) in the post-P period, and a statistically significant difference was found (p<0.05). While the number of the medical treatment approach was 112 (15.9%) in the pre-P period, it decreased to 56 (9.4%) in the post-P period and a statistically significant difference was found (p<0.05). While the number of the percutaneous coronary intervention (PCI) was 412 (58.6%) in the pre-P period, it was found 404 (68.0%) in the post-P period and a statistically significant difference was found (p<0.05). While the number of the desicions of coronary artery bypass graft (CABG) was 41 (5.8%) in the pre-P period, it decreased to 20 (3.14%) in the post-P period and a statistically significant difference was found (p<0.05). While the number of patients referred to another center was 34 (4.8%) in the pre-P period, it decreased to 8 (1.3%) in the post-P period and a statistically significant difference was observed (p<0.05). Conclusion: As a result outpatient admission was found significantly lower during pandemic period (p<0.05). There was significant increase in referrals from another center during the pandemic period (p<0.05). A significant increase was observed in the number of percutaneous coronary intervention (PCI) during the pandemic period (p<0.05). In addition, there was statistically significant decrease in the amount of medical treatment, coronary artery bypass graft (CABG) applications, and the number of patients referred to another center in the post-P period compared to pre-P period (p<0.05). Keywords: Acute coronary sendrom, pandemic, referral, emergency department admission