Predictive model of increased mortality and bed occupancy if thrombolysis becomes the initial treatment strategy for STEMI during the SARS-CoV-2 pandemic

Abstract

During the current SARS-CoV-2 pandemic the restructure of healthcare services to meet the huge increase in demand for hospital resource and capacity has led to the proposal that where necessary ST elevation myocardial infarction (STEMI) could be managed by intravenous thrombolysis in the first instance as a means of reducing the workforce requirements of a primary angioplasty service run at a heart attack centre. Our modelling, based on data from the UK, shows that contrary to reducing demand, the effect on both mortality and bed occupancy would be negative with 158 additional deaths per year for each 10% reduction in primary angioplasty and at a cost of ~8,000 additional bed days per year for the same reduction. Our analysis demonstrates that specialist services such as heart attack pathways should be protected during the COVID crisis to maximise the appropriate use of resource and prevent unnecessary mortality.

Keywords: COVID-19; STEMI; primary PCI; thrombolysis.

Fig 1.

Estimated impact of altering management strategy for primary percutaneous coronary intervention (PPCI) in the UK. a) Initial management strategy for STEMI in the UK in 2018 (n=35,740). b) Predicted increase in mortality and bed day numbers with progressive increases in thrombolysis instead of PPCI for treatment of STEMI in the UK. Based on 30-day STEMI mortality in England over 3 years to 2018. Bed day calculation based on 4-day admission for PPCI-managed STEMI and 7 day for non-PPCI managed STEMI. Data from Myocardial Ischaemia National Audit Project.