Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study
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 include...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.755822/full |
| _version_ | 1818675308261277696 |
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| author | Audrey A. Y. Zhang Nicholas W. S. Chew Cheng Han Ng Kailun Phua Yin Nwe Aye Aaron Mai Gwyneth Kong Kalyar Saw Raymond C. C. Wong Raymond C. C. Wong William K. F. Kong William K. F. Kong Kian-Keong Poh Kian-Keong Poh Koo-Hui Chan Koo-Hui Chan Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Ping Chai Ping Chai James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh |
| author_facet | Audrey A. Y. Zhang Nicholas W. S. Chew Cheng Han Ng Kailun Phua Yin Nwe Aye Aaron Mai Gwyneth Kong Kalyar Saw Raymond C. C. Wong Raymond C. C. Wong William K. F. Kong William K. F. Kong Kian-Keong Poh Kian-Keong Poh Koo-Hui Chan Koo-Hui Chan Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Ping Chai Ping Chai James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh |
| author_sort | Audrey A. Y. Zhang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T08:25:31Z |
| format | Article |
| id | doaj.art-3ea88d4e421c4581bab27566f3b60602 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T08:25:31Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-3ea88d4e421c4581bab27566f3b606022022-12-21T21:56:48ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-10-01810.3389/fcvm.2021.755822755822Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational StudyAudrey A. Y. Zhang0Nicholas W. S. Chew1Cheng Han Ng2Kailun Phua3Yin Nwe Aye4Aaron Mai5Gwyneth Kong6Kalyar Saw7Raymond C. C. Wong8Raymond C. C. Wong9William K. F. Kong10William K. F. Kong11Kian-Keong Poh12Kian-Keong Poh13Koo-Hui Chan14Koo-Hui Chan15Adrian Fatt-Hoe Low16Adrian Fatt-Hoe Low17Chi-Hang Lee18Chi-Hang Lee19Mark Yan-Yee Chan20Mark Yan-Yee Chan21Ping Chai22Ping Chai23James Yip24James Yip25Tiong-Cheng Yeo26Tiong-Cheng Yeo27Huay-Cheem Tan28Huay-Cheem Tan29Poay-Huan Loh30Poay-Huan Loh31Department of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Medicine, National University Hospital, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeBackground: 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.https://www.frontiersin.org/articles/10.3389/fcvm.2021.755822/fullCOVID-19telemedicinetelehealthST-segment elevation myocardial infarctionpandemic |
| spellingShingle | Audrey A. Y. Zhang Nicholas W. S. Chew Cheng Han Ng Kailun Phua Yin Nwe Aye Aaron Mai Gwyneth Kong Kalyar Saw Raymond C. C. Wong Raymond C. C. Wong William K. F. Kong William K. F. Kong Kian-Keong Poh Kian-Keong Poh Koo-Hui Chan Koo-Hui Chan Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Ping Chai Ping Chai James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study Frontiers in Cardiovascular Medicine COVID-19 telemedicine telehealth ST-segment elevation myocardial infarction pandemic |
| title | Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study |
| title_full | Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study |
| title_fullStr | Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study |
| title_full_unstemmed | Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study |
| title_short | Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study |
| title_sort | post st segment elevation myocardial infarction follow up care during the covid 19 pandemic and the possible benefit of telemedicine an observational study |
| topic | COVID-19 telemedicine telehealth ST-segment elevation myocardial infarction pandemic |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.755822/full |
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