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Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study
  1. Suleman Aktaa1,2,3,
  2. Mohammad E Yadegarfar4,
  3. Jianhua Wu5,
  4. Muhammad Rashid6,
  5. Mark de Belder7,
  6. John Deanfield8,
  7. Francois Schiele9,
  8. Mark Minchin10,
  9. Mamas Mamas11,
  10. Chris P Gale1,2,3
  1. 1Leeds Institute for Data analytics, University of Leeds, Leeds, UK
  2. 2Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  4. 4School of Population Health and Environmental Sciences, King's College London, London, UK
  5. 5Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK
  6. 6Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, UK
  7. 7National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
  8. 8Institute of Cardiovascular Sciences, University College London, London, UK
  9. 9Cardiology, University Hospital J Minjoz, Besancon, France
  10. 10Health and Social Care Directorate, NICE, Manchester, UK
  11. 11Institute for Science & Technology in Medicine, Keele University, Keele, UK
  1. Correspondence to Dr Suleman Aktaa, Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK; s.aktaa{at}


Background and objective The impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI.

Methods Cohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals). At the patient level, the likelihood of attainment for each QI compared with pre COVID-19 was calculated using logistic regression. The date of the first national lockdown in England and Wales (23 March 2020) was chosen for time series comparisons.

Results There were 10 749 admissions with AMI after 23 March 2020. Compared with before the lockdown, patients admitted with AMI during the first wave had similar age (mean 68.0 vs 69.0 years), with no major differences in baseline characteristics (history of diabetes (25% vs 26%), renal failure (6.4% vs 6.9%), heart failure (5.8% vs 6.4%) and previous myocardial infarction (22.9% vs 23.7%)), and less frequently had high Global Registry of Acute Coronary Events risk scores (43.6% vs 48.6%). There was an improvement in attainment for 10 (62.5%) of the 16 measured QIs including a composite QI (43.8% to 45.2%, OR 1.06, 95% CI 1.02 to 1.10) during, compared with before, the lockdown.

Conclusion During the first wave of the COVID-19 pandemic in England and Wales, quality of care for AMI as measured against international standards did not worsen, but improved modestly.

  • COVID-19
  • quality improvement
  • performance measures

Data availability statement

Data may be obtained from a third party on ethical approval and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplemental information.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data may be obtained from a third party on ethical approval and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors SA, MEY and CPG were responsible for the study design and concept. JW and MR performed the data cleaning and data analysis. SA, MEY and CPG wrote the first draft of the manuscript and all authors participated in the writing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.