To the Editor
Sutherland and colleagues recently reported a reduction in patients admitted with acute coronary syndrome (ACS) and an increase in total ischaemic time during the first and second wave of the COVID-19 outbreak in Melbourne [
[1]
]. They also observed a 20% rebound increase in ACS presentations following the relaxation of public health restrictions in November–December 2020 compared to the same period of 2019 and suggested that this could represent long-term sequelae of untreated ACS including reinfarction and heart failure. However, several additional mechanisms could play a role.Daily Life Triggers
A trend of reduced hospitalisations for all ACS types during the pandemic has been observed worldwide [
1
, 2
, 3
]. Besides social distancing, stay-at-home orders, and fear of acquiring the infection, attenuated exposure to well-recognised ACS triggers, particularly reduced air pollution, and decreased physical and work activities, has been linked to this phenomenon [- Rattka M.
- Dreyhaupt J.
- Winsauer C.
- Stuhler L.
- Baumhardt M.
- Thiessen K.
- et al.
Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis.
Heart. 2021; https://doi.org/10.1136/heartjnl-2020-318360
[3]
,- Rattka M.
- Dreyhaupt J.
- Winsauer C.
- Stuhler L.
- Baumhardt M.
- Thiessen K.
- et al.
Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis.
Heart. 2021; https://doi.org/10.1136/heartjnl-2020-318360
[4]
]. The alleviation of restrictions after the pandemic waves restored the level of exposure to ACS triggers which could have contributed to a gradual increase in ACS hospitalisations [[4]
]. Moreover, fear of lack of medical care, lockdown stress, anger, loneliness, job loss, financial stress, and binge smoking have been suggested as ACS triggers due to the ramification of the pandemic [[5]
]. Along this line, a post-restriction increase in hospitalisations for ST-segment elevation myocardial infarction has been documented in Israel [[2]
].Population Vulnerability
Anti-pandemic measures favour sedentary behaviour, physical inactivity, unhealthy nutritional habits, weight gain, and increased alcohol consumption, as confirmed by recent meta-analyses [
[6]
,- Bakaloudi D.R.
- Barazzoni R.
- Bischoff S.C.
- Breda J.
- Wickramasinghe K.
- Chourdakis M.
Impact of the first COVID-19 lockdown on body weight: a combined systematic review and a meta-analysis.
Clin Nutr. 2021; https://doi.org/10.1016/j.clnu.2021.04.015
[7]
]. Consequent negative effects on metabolism likely worsened the population’s cardiovascular health and, given their presence for over a year now, could have increased the number of vulnerable coronary patients [- Bakaloudi D.R.
- Jeyakumar D.T.
- Jayawardena R.
- Chourdakis M.
The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: a systematic review of the evidence.
Clin Nutr. 2021; https://doi.org/10.1016/j.clnu.2021.04.020
[4]
]. Accordingly, increased population cardiovascular vulnerability coupled with enhanced exposure to ACS triggers could be important mechanisms of a rebound increase in ACS.References
- Acute coronary syndrome in the COVID-19 pandemic: reduced cases and increased ischaemic time.Heart Lung Circ. 2022; 31: 69-76https://doi.org/10.1016/j.hlc.2021.07.023
- Post Covid-19 acute myocardial infarction rebound.Can J Cardiol. 2020; 36: 1832.e15-1832.e16
- Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis.Heart. 2021; https://doi.org/10.1136/heartjnl-2020-318360
- Covid-19 pandemic and possible rebound phenomenon in incidence of acute myocardial infarction.Can J Cardiol. 2021; 37: 1294
- The Covid-19 pandemic and triggered acute myocardial infarction among non-infected individuals.Int J Clin Cardiol. 2020; 7: 185
- Impact of the first COVID-19 lockdown on body weight: a combined systematic review and a meta-analysis.Clin Nutr. 2021; https://doi.org/10.1016/j.clnu.2021.04.015
- The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: a systematic review of the evidence.Clin Nutr. 2021; https://doi.org/10.1016/j.clnu.2021.04.020
Article info
Publication history
Published online: January 11, 2022
Accepted:
November 7,
2021
Received:
October 11,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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- Letter to the Editor: Acute Coronary Syndrome Trends and COVID-19 Waves (Response to the Letter of Čulić et al.)Heart, Lung and CirculationVol. 31Issue 3
- PreviewWe would like to thank Professor Čulić and colleagues for their interest in our paper [1] and for their comments [2]. We agree that multiple factors contributed to both a reduction in acute coronary syndrome (ACS) presentations during the first and second waves of the COVID-19 pandemic in Melbourne, as well as for the rebound in presentations when restrictions were eased.
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