One-month of COVID-19 lockdown cost heart attack patients up to two years of life

Newswise — Sophia Antipolis, 8 June 2023: A study published today in the European Heart Journal - Quality of Care and Clinical Outcomes reveals that patients who suffered heart attacks during the initial COVID-19 lockdown in the UK and Spain are expected to have their lifespan reduced by 1.5 and 2 years correspondingly, in comparison to their pre-pandemic counterparts. The research, conducted by the European Society of Cardiology (ESC), also estimates the economic impact on the UK and Spanish economies to be approximately £36.6 million (€41.3 million) and €88.6 million, respectively, primarily due to work absenteeism.

"Professor William Wijns from the Lambe Institute for Translational Medicine at the University of Galway, Ireland, emphasized that limitations on treating life-threatening conditions result in immediate and enduring adverse outcomes for both individuals and society. He stressed the need for contingency measures to ensure the preservation of emergency services, even in the face of natural disasters or health crises."

The prompt highlights the critical nature of promptly treating heart attacks, typically through the use of stents known as percutaneous coronary intervention (PCI). This procedure is crucial in unblocking arteries and restoring the circulation of oxygen-rich blood. Any delays in performing PCI, leading to inadequate oxygen supply, can result in irreversible harm to the heart muscle, potentially leading to heart failure or other complications. Severe damage to a significant portion of heart tissue can ultimately result in cardiac arrest, which carries a high risk of fatality.

Throughout the initial wave of the pandemic, there was a significant decline in the number of individuals seeking hospital care for heart attacks, with approximately a 40% reduction. This decrease can be attributed to government directives instructing people to stay at home, heightened fear of contracting the virus, and the suspension of certain routine emergency medical services. Tragically, individuals who chose to remain at home instead of receiving timely treatment for their heart attacks were more than twice as likely to experience fatal outcomes. Furthermore, those who delayed seeking hospital care faced nearly double the risk of encountering avoidable, severe complications.

In this study, researchers conducted an analysis to assess the long-term clinical and economic consequences stemming from the reduced treatment of heart attacks during the pandemic in the United Kingdom and Spain. The investigation involved a comparison between patients who experienced a heart attack during the initial lockdown period and those who encountered a heart attack at the same time in the preceding year. The study particularly focused on a specific type of heart attack known as ST-elevation myocardial infarction (STEMI), characterized by the complete blockage of an artery supplying blood to the heart. Additionally, the researchers evaluated the cost implications of STEMIs during the lockdown period in comparison to the corresponding period in the previous year.

To evaluate the long-term outcomes of STEMI patients, a model was developed to estimate survival rates, quality of life, and associated costs. In the UK analysis, the time period from 23rd March (the commencement of the lockdown) to 22nd April 2020 was compared to the corresponding period in 2019. In Spain, the analysis compared the month of March in 2019 with March 2020, considering that the lockdown was implemented on 14th March 2020.

The survival projections took into account factors such as age, hospitalization status, and time to treatment. These projections were based on published data specific to each country. For instance, prior to the pandemic, it was estimated that 77% of STEMI patients in the UK were hospitalized, whereas during the lockdown period, the rate dropped to 44%. In Spain, the respective rates were 74% and 57%.

Furthermore, the researchers also compared the impact on the number of healthy years lost for patients with STEMI, both before and during the pandemic. This analysis provides insights into the overall health burden experienced by STEMI patients in terms of quality-adjusted life years.

The cost analysis in the study primarily examined various components, including the expenses associated with initial hospitalization and treatment, follow-up care, management of heart failure, and the economic impact resulting from the loss of productivity in patients unable to return to work.

For instance, the cost attributed to a STEMI admission with percutaneous coronary intervention (PCI) was estimated at £2,837 in the UK and €8,780 in Spain. Furthermore, the study assessed the costs related to heart failure, with estimates amounting to £6,086 in the first year and £3,882 in each subsequent year for the UK. In Spain, the corresponding figures were €3,815 for the first year and €2,930 for each subsequent year.

These cost analyses provide insights into the financial burden associated with STEMI treatment, follow-up care, and the long-term management of heart failure in both the UK and Spain. Additionally, the study takes into account the economic implications resulting from the loss of productivity in patients who are unable to resume their work activities.

The analysis projected that individuals who experienced a STEMI amidst the initial UK lockdown would face an estimated reduction of 1.55 years in their lifespan, in contrast to patients who encountered a STEMI prior to the pandemic. Furthermore, during their remaining years, those who had a STEMI during the lockdown were anticipated to forfeit roughly one year and two months of their life in optimal well-being. The corresponding statistics for Spain indicated a loss of 2.03 years in life expectancy and approximately one year and seven months of life in perfect health.

In the UK, the increased expense associated with a single STEMI during the pandemic, in comparison to the pre-pandemic period, amounted to £8,897. This total encompassed £214 allocated to the National Health Service and £8,684 attributed to work absenteeism. With an annual incidence of 49,332 STEMIs, the restricted accessibility to PCI during the initial month of lockdown was estimated to result in an additional cost of £36.6 million (€41.3 million) throughout the lifespan of these patients.

For Spain, the added expense per STEMI amid lockdown was approximated at €20,069. Considering an annual STEMI occurrence of 52,954 cases, the constrained availability of PCI in March 2020 was anticipated to result in an extra expenditure of €88.6 million throughout the lifetimes of these patients. The primary factor contributing to this was work absence, which led to an additional cost of €23,224 per patient (€81,062 before vs. €104,286 after the pandemic). Nevertheless, this was partly balanced out by reduced expenses related to heart failure hospitalizations as more STEMI patients passed away during the lockdown.

Professor Wijns stated: "The results demonstrate the consequences of delayed or omitted healthcare. Both patients and societies will bear the consequences of diminished heart attack treatment during merely a month of lockdown for an extended period. Healthcare services should establish a roster of life-saving therapies that must always be administered, and resilient healthcare systems should be put in place, capable of swiftly transitioning to emergency protocols. Public awareness campaigns should highlight the advantages of timely care, even in the midst of a pandemic or other crises."