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新型冠状病毒肺炎对 ST 段抬高型心肌梗死差异的影响。

The COVID-19 impact on STEMI disparities.

作者信息

Folk Jessica, McGurk Kevin, Au Loretta, Imas Polina, Dhake Sarah, Haag Adam

机构信息

Division of Emergency Medicine, NorthShore University HealthSystem, USA.

University of Chicago Pritzker School of Medicine, USA.

出版信息

Heliyon. 2024 May 31;10(11):e32218. doi: 10.1016/j.heliyon.2024.e32218. eCollection 2024 Jun 15.

Abstract

ST-segment elevation myocardial infarction (STEMI) is a significant source of morbidity and mortality. Despite guideline-driven management and increased awareness of social determinants of health, there are persistent disparities in diagnosis, management, and outcomes. The coronavirus disease 2019 (COVID-19) pandemic has greatly affected emergency department visitation, conditions and throughput. The aim of this study was to find any potential health disparities in patients who presented with STEMI during the COVID-19 pandemic by reviewing STEMI care data from April to September 2019 (pre-pandemic) and April to September 2020 (during the pandemic) for our hospital system. Patients with STEMI within 12 h of presentation were included in this study, and subdivided by age, gender, and race/ethnicity. We compared the turnaround times between emergency department arrival to intervention (electrocardiogram or catheterization) within the patient subgroups to find any notable differences. No statistically significant changes in turnaround times during either study period were found based on age, gender, or race/ethnicity for the STEMI interventions despite shifts in emergency department resources during the pandemic. This study helped assess the status quo in STEMI intervention for our health system and serves as a baseline for us to monitor gaps in care or areas of improvement. As healthcare systems institute new measures to promote equitable care, such as improving the accuracy of demographic data capture, establishing a baseline is an essential first step in evaluating the impact of these measures.

摘要

ST段抬高型心肌梗死(STEMI)是发病和死亡的重要原因。尽管有指南指导的管理,且对健康的社会决定因素的认识有所提高,但在诊断、管理和治疗结果方面仍存在持续的差异。2019年冠状病毒病(COVID-19)大流行对急诊科的就诊量、状况和吞吐量产生了重大影响。本研究的目的是通过回顾我院系统2019年4月至9月(大流行前)和2020年4月至9月(大流行期间)的STEMI护理数据,找出在COVID-19大流行期间出现STEMI的患者中存在的任何潜在健康差异。本研究纳入了发病12小时内的STEMI患者,并按年龄、性别和种族/民族进行细分。我们比较了患者亚组中急诊科到达至干预(心电图或导管插入术)的周转时间,以发现任何显著差异。尽管大流行期间急诊科资源有所变化,但基于年龄、性别或种族/民族的STEMI干预在两个研究期间的周转时间均未发现统计学上的显著变化。本研究有助于评估我们医疗系统中STEMI干预的现状,并作为我们监测护理差距或改进领域的基线。随着医疗系统制定新的措施来促进公平护理,如提高人口统计数据采集的准确性,建立基线是评估这些措施影响的重要第一步。

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