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Post-Covid, a heart attack in the lockdown could shorten life by up to two years

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Post-Covid, a heart attack in the lockdown could shorten life by up to two years

Heart attack equals time-dependent pathology. Getting there early, restoring blood and oxygen to the heart, is essential. The sooner ischemia is recognized and tackled, the more effective the treatments are and the less possible long-term outcomes. But what happened when for the lockdown leaving the house was a feat and perhaps the symptoms of the heart attack were underestimated, with evident delays in treatments?

An answer comes from the research that appears on European Heart Journal – Quality of Care and Clinical Outcomes, journal of the European Society of Cardiology (ESC). And it’s certainly not encouraging. According to the author of the study, William Wines of the Lambe Institute for Translational Medicine at the Irish University of Galway, just having a heart attack during the lockdown would lead to a year and a half or two years less life expectancy, in the UK and Spain respectively. Obviously in comparison to a superimposable cardiac lesion in the pre-Covid period.

But that’s not enough. The impact of the injuries also proves to be heavy on the economic front, with additional costs to the UK and Spanish economies estimated at around €41.3m and €88.6m respectively, largely due to absence from work . What do these data teach? “Restrictions on the treatment of life-threatening conditions have immediate and long-term negative consequences for individuals and society as a whole,” comments Wijns.

Stemi infarctions are under scrutiny

The research compared the expected life expectancy of patients who had a heart attack during the first lockdown with those who had a heart attack during the same period of the previous year. The study focused on theST-segment elevation myocardial infarction (Stemi)in which an artery supplying blood to the heart is completely blocked, with specific attention to cost as well as the clinical picture.

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The Stemi heart attack, unlike the non-Stemi one (the definition is made on the basis of the electrocardiographic tracing), is thus defined on the basis of the shape of the ST segment of the electrocardiogram. When ischemia is produced by total occlusion of the coronary artery, a particular situation is recorded, i.e. the elevation of the ST segment in the derivations that “control” the ventricular wall which receives insufficient quantities of blood, which is associated with a specular depression in the derivations that explore facing walls. Experts have developed a model to estimate the long-term survival, quality of life and costs associated with these heart attacks.

Heart door

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Difficult to deal with emergencies in the lockdown

To calculate the survival projections, the experts considered age, hospitalization status and time to treatment using published data for each country. For example, using published data, it was estimated that 77% of Stemi patients in the UK were hospitalized before the pandemic compared to 44% during the lockdown. The equivalent rates for Spain were 74% and 57%. The researchers also compared how many years of perfect health were lost for patients with Stemi.

The analysis predicted that patients who experienced an STEM during the first UK lockdown would lose an average of 1.55 years of life compared to patients experiencing such a heart attack before the pandemic. Also, while alive, those with a Stemi during the lockdown were expected to lose about a year and two months of life in perfect health. The equivalent figures for Spain were 2.03 years of life lost and about one year and seven months of life lost in perfect health.

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On the cost front in the UK, at an incidence of 49,332 SEMIs per year, reduced access to angioplasty treatment during the first month of lockdown would have cost an extra 41.3 million euros over the lifetime of these patients. For Spain, the additional cost for each Stemi during the lockdown has been estimated at €20,069 for a total of nearly €90 million. According to Wins “patients and societies will pay the price of reducing heart attack treatment during a single month of lockdown for years to come. Health services need a list of life-saving therapies that should always be provided and must be instituted resilient health systems that can transition to emergency plans without delay.”

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Decline in hospitalizations also in Italy

Some time ago, onEuropean Heart Journal data relating to the analysis conducted by the Italian Society of Cardiology (SIC) on the clinical impact of this situation have been published. Ciro Indolfi, President at the time, commented on the weight of the reduction in urgent hospitalizations for cardiovascular diseases in the first period of the Covid pandemic. “About 50% of patients with heart attack, heart failure and other serious acute pathologies did not go to hospital, or went late, for fear of contagion and this has tripled hospital mortality due to Stemi heart attack – reports Indolfi”. Today, also on the basis of new data, it is always necessary to remember how the promptness of the aid and the rapid access to treatments is the variable that allows the history of the heart attack to change. If you get there early, open the blocked artery, and restore blood to the ischemic myocardium, you could save more lives. And you can have less serious outcomes for those who overcome the heart attack.

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