van den Bulk Simone, van Egeraat Jasper W A, Petrus Annelieke H J, Numans Mattijs E, Bonten Tobias N
Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands.
BMC Prim Care. 2024 Dec 21;25(1):433. doi: 10.1186/s12875-024-02676-y.
The COVID-19 lockdown had profound effects on society and healthcare. Cardiology departments reported declines in chest pain evaluations and acute coronary syndrome (ACS) diagnoses. However, the pattern of chest pain in primary care is not clear yet. This study aims to assess the impact of the COVID-19 lockdown on the number of patients presenting with chest pain in primary care.
Routine primary care data from the Extramural LUMC (Leiden University Medical Center) Academic Network (ELAN) in the Netherlands were used. Chest pain consultations from January 2017 to December 2020 were included. An interrupted time series analysis was performed to compare the incidence rate (IR) of chest pain consultations during the COVID-19 lockdown to the expected IR. Secondary outcomes were the type of consultations, referral proportions, and the IR of registered ACS diagnoses.
In total 9,908 chest pain consultations were included. During the COVID-19 lockdown the IR was 6.16 per 1000 person-years while the expected IR was 7.55 (95% CI 7.03-8.12). The immediate effect of the lockdown yielded an incidence rate ratio (IRR) of 0.62 (95% CI 0.50-0.77). A similar decrease was seen for ACS diagnoses (IRR 0.62, 95% CI 0.48-0.79), with no compensatory increase after the lockdown (IRR 1.04, 95% CI 0.89-1.21). Face-to-face consultations shifted to telephone consultations (p < 0.001) and hospital referrals decreased (9.9% vs. 19.0% (p < 0.001)).
During the COVID-19 lockdown the number of chest pain consultations and registered ACS diagnoses in primary care decreased significantly. In addition, fewer patients were assessed face-to-face and fewer patients were referred to the hospital.
新冠疫情封锁对社会和医疗保健产生了深远影响。心脏病学部门报告称胸痛评估和急性冠状动脉综合征（ACS）诊断数量有所下降。然而，初级保健中胸痛的模式尚不清楚。本研究旨在评估新冠疫情封锁对初级保健中胸痛患者数量的影响。
使用了荷兰莱顿大学医学中心（LUMC）校外学术网络（ELAN）的常规初级保健数据。纳入了2017年1月至2020年12月期间的胸痛会诊。进行了中断时间序列分析，以比较新冠疫情封锁期间胸痛会诊的发病率（IR）与预期发病率。次要结果是会诊类型、转诊比例以及注册ACS诊断的发病率。
共纳入9908例胸痛会诊。在新冠疫情封锁期间，发病率为每1000人年6.16例，而预期发病率为7.55（95%可信区间7.03 - 8.12）。封锁的即时影响产生的发病率比（IRR）为0.62（95%可信区间0.50 - 0.77）。ACS诊断也有类似下降（IRR 0.62，95%可信区间0.48 - 0.79），封锁后没有补偿性增加（IRR 1.04，95%可信区间0.89 - 1.21）。面对面会诊转向了电话会诊（p < 0.001），医院转诊减少（9.9%对19.0%（p < 0.001））。
在新冠疫情封锁期间，初级保健中胸痛会诊和注册ACS诊断的数量显著下降。此外，面对面评估的患者减少，转诊至医院的患者也减少。
