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Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Early during the COVID-19 pandemic, marked declines in patients presenting with acute cardiovascular conditions were observed,1,2 whereas mortality attributed to cardiovascular causes increased.3 This raised concerns that patient reluctance to seek emergency care contributed to preventable complications and excess deaths, and public health campaigns sought to reassure patients that hospitals were safe and to encourage seeking care when needed. As COVID-19 resurged in late 2020, rates of infections, hospitalizations, and deaths exceeded those of previous surges. Many countries reimplemented lockdowns, and recent UK data indicate that presentations for emergent cardiovascular conditions again declined.4 We evaluated changes in rates of acute myocardial infarction (AMI) hospitalizations and suspected ischemic stroke as measures of patient willingness to seek emergency care during the most recent COVID-19 surges in the US.

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Article Information

Corresponding Author: Matthew D. Solomon, MD, PhD, Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611 (matthew.d.solomon@kp.org).

Accepted for Publication: May 10, 2021.

Published Online: June 2, 2021. doi:10.1001/jama.2021.8414

Author Contributions: Dr Solomon had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Solomon, Nguyen-Huynh, Rana, Klingman, Go.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Solomon, Nguyen-Huynh, Leong, Go.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Solomon, Leong, Alexander.

Obtained funding: Solomon.

Administrative, technical, or material support: Solomon, Nguyen-Huynh, Leong.

Supervision: Solomon, Nguyen-Huynh, Go.

Conflict of Interest Disclosures: Dr Solomon reported receiving grants from The Permanente Medical Group and the Kaiser Permanente Garfield Memorial Fund during the conduct of the study. Dr Nguyen-Huynh reported receiving grants from The Permanente Medical Group and the Kaiser Permanente Garfield Memorial Fund during the conduct of the study. Dr Go reported receiving grants from The Permanente Medical Group and the Garfield Memorial Fund during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was sponsored by grants from the Kaiser Permanente Garfield Memorial Fund and The Permanente Medical Group Delivery Sciences and Applied Research Program.

Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Additional Contributions: We acknowledge additional persons who contributed to the work, including Edward J. McNulty, MD (Department of Cardiology, Kaiser Permanente Northern California), for contributions to concept and design and analysis and interpretation of the data, and Sue Hee Sung, MPH (Division of Research, Kaiser Permanente Northern California), for contributions to supervision and administrative, technical, and material support. No one received financial compensation for their contributions.

References
1.
Solomon  MD , McNulty  EJ , Rana  JS ,  et al.  The Covid-19 pandemic and the incidence of acute myocardial infarction.   N Engl J Med. 2020;383(7):691-693. doi:10.1056/NEJMc2015630PubMedGoogle ScholarCrossref
2.
Nguyen-Huynh  MN , Tang  XN , Vinson  DR ,  et al.  Acute stroke presentation, care, and outcomes in community hospitals in Northern California during the COVID-19 pandemic.   Stroke. 2020;51(10):2918-2924. doi:10.1161/STROKEAHA.120.031099PubMedGoogle ScholarCrossref
3.
Wadhera  RK , Shen  C , Gondi  S , Chen  S , Kazi  DS , Yeh  RW .  Cardiovascular deaths during the COVID-19 pandemic in the United States.   J Am Coll Cardiol. 2021;77(2):159-169. doi:10.1016/j.jacc.2020.10.055PubMedGoogle ScholarCrossref
4.
Wu  J , Mamas  MA , de Belder  MA , Deanfield  JE , Gale  CP .  Second decline in admissions with heart failure and myocardial infarction during the COVID-19 pandemic.   J Am Coll Cardiol. 2021;77(8):1141-1143. doi:10.1016/j.jacc.2020.12.039PubMedGoogle ScholarCrossref
5.
Gordon  N , Lin  T .  The Kaiser Permanente Northern California adult member health survey.   Perm J. 2016;20(4):15-225. doi:10.7812/TPP/15-225PubMedGoogle Scholar
6.
Nguyen-Huynh  MN , Klingman  JG , Avins  AL ,  et al; KPNC Stroke FORCE Team.  Novel telestroke program improves thrombolysis for acute stroke across 21 hospitals of an integrated healthcare system.   Stroke. 2018;49(1):133-139. doi:10.1161/STROKEAHA.117.018413PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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