Effect of COVID-19 pandemic lockdown on emergency medical service utilisation, and percutaneous coronary intervention (PCI) volume - an Australian perspective.

Abstract

Background: Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described. Methods: PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE), and EMS utilisation were compared over four time periods: lockdown (March–May 2020); pre-lockdown (February–March 2020); post-lockdown (May–July 2020); and the year prior (March–May 2019). Results: EMS utilisation for ACS was higher during lockdown: lockdown 39.4% versus pre-lockdown 29.7%; versus post-lockdown 33.6%; versus year prior 27.1%, all p<0.01. Median daily PCI cases were similar: 31 (10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and 42 (10, 49) the year prior, all p>0.05. Median door to procedure time for ACS indication during lockdown was shorter at 3 hours versus pre-lockdown 3.9 hours; versus post-lockdown 3.5 hours; and the year prior 3.5 hours, all p<0.05. The lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (OR 0.55 [0.33, 0.93] p=0.026); post-lockdown (OR 0.66 [0.40, 1.06] p=0.087); and the year prior (OR 0.55 [0.33, 0.93] p=0.026). Conclusion: EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.