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MYOCARDIAL INFARCTION RATES DURING THE PANDEMIC
AND THE PRE-PANDEMIC PERIOD
Muminov S.J
Center for the Development of Professional Qualifications of Medical
Workers, Uzbekistan
Relevance.
The recent and ongoing coronavirus pandemic has taken
over almost the entire world. Despite the severity of the COVID-19 problem,
mortality from this disease is in no way comparable to mortality from
cardiovascular disease (CVD), which remains the leading cause of death
among the population. Of course, the increase in mortality directly and
indirectly depends on the clinical forms of this virus [1, 3, 4].
COVID-19 can cause additional damage to the cardiovascular system,
which contributes to the development of complications and exacerbation of
coronary artery disease. Furthermore, the choice of priority tactics in the
diagnosis of COVID-19 and a combination of cardiovascular pathology and
the treatment of patients in emergency situations poses a number of challenges
[5, 6].
The new strain of the SARS-CoV-2 coronavirus is a single-stranded
RNA virus phylogenetically similar to another SARS-CoV coronavirus,
causing 10% of deaths among patients diagnosed with SARS in 2003[7]. It is
known that COVID-19 is especially severe in elderly people, as they are the
most common causes of various cardiovascular diseases, arterial hypertension
(AH), and chronic heart failure (CHF). Therefore, there is reason to believe
that the COVID-19 pandemic can lead to an increase in the mortality rate from
heart failure in these patients. Comparative assessment of myocardial
infarction cases in the pandemic and pre-pandemic periods.
Objects and methods of verification
Our research was conducted at the Namangan Regional Branch of the
Republican Center for Emergency Medical and Scientific-Practical
Cardiology. Based on a retrospective analysis, the scientific study involved
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304 patients hospitalized with a diagnosis of myocardial infarction before and
during the pandemic. Of these, 139 patients were patients with myocardial
infarction in the pre-pandemic period, and 165 were patients with myocardial
infarction during the pandemic period. Of the 165 patients, 61 had myocardial
infarction (MI) and COVID-19, while 104 had only MI. Of the 139 patients,
86 (62%) were male and 63 (38%) were female. Of the 165 patients with MI
registered in the context of the pandemic, 98 (68%) were men and 67 (32%)
were women.
Of the patients, 203 (49.7%) were transported to the hospital by
ambulance, while 101 (33%) were transported by their own vehicle. The
average age of the patients examined ranged from 48 to 75 years. The diagnosis
of myocardial infarction was made in accordance with the recommendations
of the European Society of Cardiologists in 2018. Retrospective studies
covered the period before the pandemic, that is, from December 2018 to
December 2019, while the study conducted during the pandemic covered the
period from January 2020 to January 2022. Special maps were created for the
patients involved in the study. The card included the following indicators:
passport part, complaint, medical history, duration of the illness,
comorbidities, laboratory and instrumental studies. The data obtained during
the study was statistically processed on a Pentium IV personal computer using
the Microsoft Office Excel - 2013 software package, including the use of
internal statistical processing functions, as well as the use of the
STATISTICA-6.0 software package.
Analysis of the results obtained
Using the retrospective method, we analyzed the number of patients
hospitalized with myocardial infarction, according to which the total number
of patients in the pre-pandemic period was 139. Of these, 86 (62%) were men
and 63 (38%) were women. Our analysis of patients by age showed that 79
(57%) were elderly patients over 60 years old and 60 (43%) were middle-aged
patients. Thus, men with myocardial infarction before the pandemic had a
significantly higher rate of 36.5% (p<0.01) than women, while those over 60
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years old had a 32% (p<0.01) higher rate than those under 60 years old (Figure
1).
Appendix: **p<0.01 significant intergroup indicator
Figure1. Analysis of patients with MI in the pre-pandemic period by
age and gender (%)
During the pandemic, the number of patients with myocardial infarction
increased to 165, while before the pandemic, their number was 139, meaning
the number of patients increased by 19%. Of the 165 patients, 61 (37%) had
the virus, while the remaining 104 (63%) had no confirmed viral infection.
Of the 61 patients in the MI+B group, 49 (80%) were
elderly, while 12 (19.7%) were middle-aged. In our analysis of patients in
terms of gender, out of 61 patients with MI+B, 23 (37.7%) were female and 38
(60.5%) were male (Figure 2). During the COVID-19 pandemic, the time for
seeking emergency medical care for patients without coronavirus infection was
11.1 ± 3.3 hours, while in the pre-pandemic period it was 3.6 ± 1.1 hours (33%,
(p<0.01) compared to the pre-pandemic period).
0
10
20
30
40
50
60
70
80
woman
man
>60
<60
38
62**
79**
60
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Appendix: **p<0.01 significant intergroup indicator
Figure 3.1.2 Analysis of patients with MI during the pandemic by age
and gender (%)
The data presented in the figure shows that even in the context of the
pandemic, the incidence of myocardial infarction in patients with viral
infection is 60% higher in men than in women (p<0.01), while in elderly
patients it is 24.5% higher than in middle-aged patients (p<0.01). Through the
retrospective method, we observed that patients who had not yet been infected
with the virus were delayed in calling the emergency medical service during
the COVID-19 pandemic. This significantly increases the time of coronary
reperfusion, which in turn affects the spread of myocardial damage. The
average time for our patients with viral infections and myocardial infarction to
seek medical attention was 16.1 ± 3.1 hours (a difference of 22.5% (p<0.01)
compared to the pre-pandemic period). As you can see, these results differed
significantly from those before the pandemic. (Figure 3.)
0
10
20
30
40
50
60
70
80
аёллар
эркаклар
>60
<60
37,7
60,5**
80,0**
19,7
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Appendix: **p<0.01 significant intergroup indicator, POD - pre-pandemic
period, MI - myocardial infarction, MI+V - myocardial infarction, and viral
infection
Figure 3. Time of the patient's appeal to emergency medical care
(hours)
Despite the more complex healthcare situation during the pandemic, the
ambulance service has shown its effectiveness, but despite this, the average
time for first-class calls has increased from 16 minutes to 36 minutes. We
analyzed the reasons for the delay in seeking emergency medical care during
the pandemic in patients with MI and not yet diagnosed with the virus, as well
as in patients diagnosed with MI+V. Sixty-one patients with MI and viral
infection responded to the question why they sought emergency medical care
late: 11 (18%) sought emergency medical care by phone, but due to certain
reasons, emergency medical care (EMC) remained late. Of course, during this
period, emergency services focused on combating the virus, and most medical
resources were directed towards combating the virus.
However, 31 (51%) responded that the reason for the delay in visiting
doctors was the fear of being infected with the virus (VV), while 19 (31%)
3,5
11,1**
16,1**
0
2
4
6
8
10
12
14
16
18
POD
MI
MI+V
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responded that there were no vacancies in hospitals. During outpatient
observation, we evaluated measures against modified cardiovascular disease
risk factors in patients with a history of viral infection. We observed that data
on modified risk factors for cardiovascular disease, namely: arterial
hypertension, dyslipidemia, and diabetes mellitus, were included in the
patient's outpatient chart. Extensive div weight or obesity were covered in
outpatient charts as a diagnosis, but we witnessed that patients were not
provided with enough information to correct it.
The current blood pressure
values of patients were reflected in the outpatient records of 53 (88%) out of
60 patients, but given the leading role of hypertension in the development of
MI, such an important diagnostic indicator should have been recorded in all
patients without exception. Blood pressure control can be assessed as
unsatisfactory, as at the first visit of patients, the systolic blood pressure (SBP)
value was 141.3±13.7 mmHg, while the diastolic blood pressure (DAP) value
was 89.6±6.3 mmHg.
It
should be noted that. To determine the risk of cardiovascular disease and
further treatment tactics, it is necessary to determine lipid metabolism in the
blood. Based on the data we obtained, it can be said that doctors did not pay
sufficient attention to the determination of blood lipids in patients. According
to an analysis of outpatient records, outpatient records of only 35 (58.3%) out
of 60 patients included blood lipid levels. However, it should be noted that
only total cholesterol and triglyceride levels were studied in 11 (31%) of these
35 patients. In the population of patients we studied, average lipid levels were
not only above the target level for patients who had experienced myocardial
infarction, but also exceeded the target lipid level for individuals with a low
risk of developing cardiovascular complications. Thus, the average value of
total cholesterol (TC) in the examined patients was 6.6±1.1 mmol/L, T -
2.9±0.6 mmol/L, and LDL - 3.0±0.8 mmol/L. It is known that diabetes is the
most important risk factor for the development of cardiovascular disease.
Therefore, blood sugar monitoring is important not only in outpatient settings
but also in inpatient settings. The outpatient records of our patients were
insufficient for fasting blood glucose levels, which suggests that doctors did
not pay sufficient attention to this risk factor.
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In the course of the study, we noticed that blood sugar levels were
mainly assessed in patients with a history of diabetes, how correct is this?
Outpatient records of only 15 (25%) of our patients with MI and viral infection
showed the value of sugar. Data on the determination of blood glucose and
glycated hemoglobin in the studied population is only available in 3 (5.0%)
patients. This is why serious attention is paid to patients with MI and viral
infection, as these patients have a greater chance of developing adequate
complications in the next stage of MI. It was in the post-COVID period that
63% (n=38) of our patients experienced depression. Our patients had both sides
of fear, on the one hand they had experienced myocardial infarction, and on
the other hand they had COVID-19.
Conclusion:
During the pandemic, the
number of patients hospitalized with a diagnosis of myocardial infarction
increased by 19% compared to the pre-pandemic period.The majority of
patients with myocardial infarction were elderly and men.It was noted that
patients with myocardial infarction delayed seeking emergency medical care
during the COVID-19 pandemic.51% of patients with myocardial infarction
delayed seeking emergency care due to fear of viral infection. Doctors paid
very little attention to early detection of almost all major risk factors for
cardiovascular diseases and of course, this situation does not affect the quality
of pharmacotherapeutic correction of patients.
Literature:
1.
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular
implications of fatal outcomes of patients with coronavirus disease 2019
(COVID-19). JAMA cardiology. 2020; doi:10.1001/jamacardio.2020.1017
2.
Batlle D, Wysocki J, Satchell K. Soluble angiotensin-converting enzyme 2: a
potential approach for coronavirus infection therapy? Clin Sci.
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3.
Gallagher P, Ferrario C, Tallant E. Regulation of ACE 2 in cardiac myocytes
and fibroblasts. Am J Physiol Heart Circ Physiol. 2008;295(6):H2373-H2379.
4.
Imai Y, Kuba K, Penninger JM. The discovery of angiotensin-converting
enzyme 2 and its role in acute lung injury in mice. Experimental Physiology.
2008;93(5):543-8.
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5.
Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B et al. Angiotensin-converting
enzyme
2
protects
from
severe
acute
lung
failure.
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Gallagher P, Ferrario C, Tallant E. Regulation of ACE 2 in cardiac myocytes
and fibroblasts. Am J Physiol Heart Circ Physiol. 2008;295(6):H2373-H2379.
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Imai Y, Kuba K, Penninger JM. The discovery of angiotensin-converting
enzyme 2 and its role in acute lung injury in mice. Experimental Physiology.
2008;93(5):543-8.
