Impacts of Avoiding Emergency Department Visits During the COVID-19 Pandemic Among Patients With Acute Ischemic Heart Events.

Abstract

Purpose: The COVID-19 pandemic significantly disrupted healthcare services as individuals avoided medical facilities to reduce the risk of infection. Despite Taiwan's effective public health measures and low SARS-CoV-2 case numbers in 2020, emergency department (ED) utilization patterns still changed, particularly for cases with acute ischemic heart events. This study investigated how the pandemic influenced medical avoidance in such cases and assessed potential collateral damage and adverse outcomes in an ED that managed limited COVID-19 instances during this period.

Methods: An observational cross-sectional study was conducted on adult ED visits at a tertiary hospital from January 2017 to December 2020, focusing on symptoms associated with acute ischemic heart events and complications. Data was retrospectively collected from electronic medical records (EMRs), including demographics, clinical characteristics, visit times, discharge times, disposition types, triage levels, International Classification of Diseases-9th Revision (ICD-9) and International Classification of Diseases-10th Revision (ICD-10)-based diagnoses, and vital signs.

Results: The study observed a 20-30% decline in adult ED visits in 2020, with a notable 29% decrease in semi-urgent (level 3) triage visits from February to May. The largest declines occurred among patients aged 80 and above, with reductions up to 44.4% in March. Acute ischemic heart cases decreased in early 2020 but rebounded by April and May. However, acute ischemic heart-related complications increased consistently throughout the year, particularly in January (61% vs 77%, p=0.02) and October (59% vs 77%, p=0.04).

Conclusion: These findings highlight the indirect impact of the pandemic on critical care access, even in regions with low prevalence. Medical avoidance reduced ED visits but increased the risk of complications of acute ischemic heart. Addressing barriers to timely care and implementing targeted response strategies are essential to ensure access to life-saving treatments and mitigate long-term adverse health consequences during public health crises.