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

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.

Keywords: COVID-19; coronary heart disease; health services accessibility; public health.