AUTHOR=Zhang Audrey A. Y. , Chew Nicholas W. S. , Ng Cheng Han , Phua Kailun , Aye Yin Nwe , Mai Aaron , Kong Gwyneth , Saw Kalyar , Wong Raymond C. C. , Kong William K. F. , Poh Kian-Keong , Chan Koo-Hui , Low Adrian Fatt-Hoe , Lee Chi-Hang , Chan Mark Yan-Yee , Chai Ping , Yip James , Yeo Tiong-Cheng , Tan Huay-Cheem , Loh Poay-Huan 

TITLE=Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.755822

DOI=10.3389/fcvm.2021.755822

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Infectious control measures during the COVID-19 pandemic have led to the propensity toward telemedicine. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients.</p><p><bold>Methods:</bold> This study included 288 patients admitted 1 year before the pandemic (October 2018–December 2018) and during the pandemic (January 2020–March 2020) eras, and survived their index STEMI admission. The follow-up period was 1 year. One-year primary safety endpoint was all-cause mortality. Secondary safety endpoints were cardiac readmissions for unplanned revascularisation, non-fatal myocardial infarction, heart failure, arrythmia, unstable angina. Major adverse cardiovascular events (MACE) was defined as the composite outcome of each individual safety endpoint.</p><p><bold>Results:</bold> Despite unfavorable in-hospital outcomes among patients admitted during the pandemic compared to pre-pandemic era, both groups had similar 1-year all-cause mortality (11.2 vs. 8.5%, respectively, <italic>p</italic> = 0.454) but higher cardiac-related (14.1 vs. 5.1%, <italic>p</italic> &lt; 0.001) and heart failure readmissions in the pandemic vs. pre-pandemic groups (7.1 vs. 1.7%, <italic>p</italic> = 0.037). Follow-up was more frequently conducted via teleconsultations (1.2 vs. 0.2 per patient/year, <italic>p</italic> = 0.001), with reduction in physical consultations (2.1 vs. 2.6 per patient/year, <italic>p</italic> = 0.043), during the pandemic vs. pre-pandemic era. Majority achieved guideline-directed medical therapy (GDMT) during pandemic vs. pre-pandemic era (75.9 vs. 61.6%, <italic>p</italic> = 0.010). Multivariable Cox regression demonstrated achieving medication target doses (HR 0.387, 95% CI 0.164–0.915, <italic>p</italic> = 0.031) and GDMT (HR 0.271, 95% CI 0.134–0.548, <italic>p</italic> &lt; 0.001) were independent predictors of lower 1-year MACE after adjustment.</p><p><bold>Conclusion:</bold> The pandemic has led to the wider application of teleconsultation, with increased adherence to GDMT, enhanced medication target dosing. Achieving GDMT was associated with favorable long-term prognosis.</p>