Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study

• Published in: Frontiers in cardiovascular medicine Vol. 8; p. 755822
• Main Authors: Zhang, Audrey A. Y., Chew, Nicholas W. S., Ng, Cheng Han, Phua, Kailun, Aye, Yin Nwe, Mai, Aaron, Kong, Gwyneth, Saw, Kalyar, Wong, Raymond C. C., Kong, William K. F., Poh, Kian-Keong, Chan, Koo-Hui, Low, Adrian Fatt-Hoe, Lee, Chi-Hang, Chan, Mark Yan-Yee, Chai, Ping, Yip, James, Yeo, Tiong-Cheng, Tan, Huay-Cheem, Loh, Poay-Huan
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 22.10.2021
• Subjects: Cardiovascular Medicine; COVID-19; pandemic; ST-segment elevation myocardial infarction; telehealth; telemedicine
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2021.755822

Background: Infectious control measures during the COVID-19 pandemic have led to the propensity toward telemedicine. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients. Methods: This study included 288 patients admitted 1 year before the pandemic (October 2018–December 2018) and during the pandemic (January 2020–March 2020) eras, and survived their index STEMI admission. The follow-up period was 1 year. One-year primary safety endpoint was all-cause mortality. Secondary safety endpoints were cardiac readmissions for unplanned revascularisation, non-fatal myocardial infarction, heart failure, arrythmia, unstable angina. Major adverse cardiovascular events (MACE) was defined as the composite outcome of each individual safety endpoint. Results: Despite unfavorable in-hospital outcomes among patients admitted during the pandemic compared to pre-pandemic era, both groups had similar 1-year all-cause mortality (11.2 vs. 8.5%, respectively, p = 0.454) but higher cardiac-related (14.1 vs. 5.1%, p < 0.001) and heart failure readmissions in the pandemic vs. pre-pandemic groups (7.1 vs. 1.7%, p = 0.037). Follow-up was more frequently conducted via teleconsultations (1.2 vs. 0.2 per patient/year, p = 0.001), with reduction in physical consultations (2.1 vs. 2.6 per patient/year, p = 0.043), during the pandemic vs. pre-pandemic era. Majority achieved guideline-directed medical therapy (GDMT) during pandemic vs. pre-pandemic era (75.9 vs. 61.6%, p = 0.010). Multivariable Cox regression demonstrated achieving medication target doses (HR 0.387, 95% CI 0.164–0.915, p = 0.031) and GDMT (HR 0.271, 95% CI 0.134–0.548, p < 0.001) were independent predictors of lower 1-year MACE after adjustment. Conclusion: The pandemic has led to the wider application of teleconsultation, with increased adherence to GDMT, enhanced medication target dosing. Achieving GDMT was associated with favorable long-term prognosis.