Impact of the Covid-19 pandemic on stroke and ST-segment elevation myocardial infarction patient management: French regional registry
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CHU de Bordeaux, France
Bordeaux Population Health, University of Bordeaux, Bordeaux, France
Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
CHU de Bordeaux
Coronary Care Unit, Hôpital Cardiologique, CHU de Bordeaux, Nouvelle-Aquitaine, France
Pôle de médecine d'urgence, CHU de Bordeaux, Bordeaux, France
Stroke Unit, Department of Neurology, CHU de Bordeaux, France
Bordeaux Population Health, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux Population Health, University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A346
Background and Objective: Around the world, the consequences of the COVID-19 pandemic on the management of no-COVID-19 pathologies are causing concerns. We aimed to assess the impact of changes in use of care and health reorganizations implementation spurred by the COVID-19 pandemic (first wave), on acute management times of strokes and ST-segment elevation myocardial infarctions (STEMI). Methods: The study was based on two cohorts of stroke and STEMI patients included between January 2019 and August 2020 in a French regional registry. The hospital reorganizations were systematically collected from heads of hospital departments. The associations between reorganizations, use of care, and care management times were analyzed through multivariate linear regression mixed models. Interaction terms between the use of care variables and the period (pre, per, post-wave) were introduced. Results: A total of 9,218 patients were included (6,436 stroke and 2,782 STEMI patients). Per-wave period management times deteriorated for stroke but maintained for STEMI. Per-wave changes in use of care did not have any impact on STEMI management. No association was found between reorganizations and stroke management times. In the STEMI cohort, the implementation of a systematic testing at admission was associated with an increase of 41% in care management times (exp=1.409, 95%CI [1.075-1.848], p=0.013); the implementation of the global “plan blanc”, concentrating resources in emergency activities, was associated with a decrease of 19% in management times (exp=0.801, 95%CI [0.639-1.023], p=0.077). Conclusions: The pandemic induced no deep altering of emergency pathway structuration. The better resilience of the STEMI pathway than the stroke one is interpreted as linked with its stronger structuration. Transversal reorganizations aiming at concentrate resources on emergency care contributed to maintaining quality of care.