{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:37:49Z","timestamp":1789580269312,"version":"build-2803163510"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Importance<\/jats:title>The incidence of hospital encounters for acute myocardial infarction (AMI) decreased sharply early in the COVID-19 pandemic and has not returned to prepandemic levels. There has been an ongoing debate about what mechanism may underlie this decline, including patients avoiding the hospital for treatment, excess mortality from COVID-19 among patients who would otherwise have had an AMI, a reduction in the incidence or severity of AMIs due to pandemic-related changes in behavior, or a preexisting temporal trend of lower AMI incidence.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe drivers of changing incidence in AMI hospital encounters during the COVID-19 pandemic.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study used traditional Medicare claims from all patients enrolled in traditional Medicare from January 2016 to June 2023 (total of 2.85 billion patient-months) to calculate the rate of AMI hospital encounters (emergency department visits, observation stays, or inpatient admissions) per capita at all short-term acute care and critical access hospitals in the United States overall and by patient characteristics. Observed rates were compared with expected rates that accounted for shifts in population characteristics and the prepandemic temporal trend (as estimated over 2016-2019). Data were analyzed in November 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Hospital encounters for AMI.<\/jats:p><\/jats:sec>Results<\/jats:title>On average, the study sample included 31\u202f623\u202f928 patients each month from January 2016 through June 2023, for a total of 2\u202f846\u202f153\u202f487 patient-months during the 90-month study period. In June 2023, there were 0.044 AMI hospital encounters per 100 patients, which was 20% lower than in June 2019 (0.055 encounters per 100 patients). Early in the pandemic, AMI rates moved inversely with COVID-19 death rates and tracked patterns seen for other painful acute conditions, such as nephrolithiasis, suggesting these changes were associated with care avoidance. Changes in patient characteristics driven by excess deaths during the pandemic explained little of the decline. Later in the pandemic, the decline may be explained by the long-standing downward trend in AMI incidence; by April 2022, the observed rate of encounters matched the expected rate that accounted for this trend. During the full pandemic period, from March 2020 to June 2023, there were an estimated 5% (95% prediction interval, 1%-9%) fewer AMI hospital encounters than expected.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The early reduction in AMI encounters was likely driven by care avoidance, while ongoing reductions through June 2023 likely reflect long-standing temporal trends. During the pandemic, there were 5% fewer AMI encounters than expected.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2024.2031","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T17:16:02Z","timestamp":1722446162000},"page":"914","source":"Crossref","is-referenced-by-count":7,"title":["Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic"],"prefix":"10.1001","volume":"9","author":[{"given":"Andrew D.","family":"Wilcock","sequence":"first","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose R.","family":"Zubizarreta","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Department of Statistics, Harvard University, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi K.","family":"Wadhera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kori S.","family":"Zachrison","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Emergency Medicine, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H.","family":"Schwamm","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ateev","family":"Mehrotra","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"hbr240007r1","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1377\/hlthaff.2020.00980","article-title":"The impact of the COVID-19 pandemic on hospital admissions in the United States.","volume":"39","author":"Birkmeyer","year":"2020","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"hbr240007r2","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1001\/jama.2021.8414","article-title":"Changes in patterns of hospital visits for acute myocardial infarction or ischemic stroke during COVID-19 surges.","volume":"326","author":"Solomon","year":"2021","journal-title":"JAMA"},{"issue":"9","key":"hbr240007r3","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1377\/hlthaff.2021.00561","article-title":"National trends in ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.","volume":"40","author":"Smulowitz","year":"2021","journal-title":"Health Aff (Millwood)"},{"issue":"11","key":"hbr240007r4","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1001\/jamacardio.2021.2729","article-title":"Hospital use for myocardial infarction and stroke among Medicare beneficiaries from March to December 2020.","volume":"6","author":"Stewart","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"6","key":"hbr240007r7","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1377\/hlthaff.2020.02521","article-title":"COVID-19-related deaths and excess deaths among Medicare fee-for-service beneficiaries.","volume":"40","author":"Tarazi","year":"2021","journal-title":"Health Aff (Millwood)"},{"issue":"24","key":"hbr240007r9","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1056\/NEJMms2009984","article-title":"The untold toll\u2014the pandemic\u2019s effects on patients without Covid-19.","volume":"382","author":"Rosenbaum","year":"2020","journal-title":"N Engl J Med"},{"issue":"6","key":"hbr240007r10","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1377\/hlthaff.2021.00250","article-title":"Worse cardiac arrest outcomes during the COVID-19 pandemic in Boston can be attributed to patient reluctance to seek care.","volume":"40","author":"Sun","year":"2021","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"hbr240007r12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1159\/000507666","article-title":"The baffling case of ischemic stroke disappearance from the casualty department in the COVID-19 era.","volume":"83","author":"Morelli","year":"2020","journal-title":"Eur Neurol"},{"issue":"8","key":"hbr240007r13","doi-asserted-by":"publisher","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke statistics\u20142023 update: a report from the American Heart Association.","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"issue":"2","key":"hbr240007r14","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jacc.2020.10.055","article-title":"Cardiovascular deaths during the COVID-19 pandemic in the United States.","volume":"77","author":"Wadhera","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"24","key":"hbr240007r15","doi-asserted-by":"publisher","first-page":"2346","DOI":"10.1161\/CIRCULATIONAHA.121.054378","article-title":"Racial and ethnic disparities in heart and cerebrovascular disease deaths during the COVID-19 pandemic in the United States.","volume":"143","author":"Wadhera","year":"2021","journal-title":"Circulation"},{"key":"hbr240007r5","unstructured":"Kolata? G. Amid the coronavirus crisis, heart and stroke patients go missing. New York Times. April 25, 2020. Accessed March 6, 2022. https:\/\/www.nytimes.com\/2020\/04\/25\/health\/coronavirus-heart-stroke.html"},{"key":"hbr240007r6","unstructured":"Krumholz? HM. Where have all the heart attacks gone? New York Times. April 6, 2020. Accessed March 6, 2022. https:\/\/www.nytimes.com\/2020\/04\/06\/well\/live\/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html"},{"key":"hbr240007r8","unstructured":"Wong? LE, Hawkins? JE, Langness? S, Murrell? KL, Iris? P, Sammann? A. Where are all the patients? addressing Covid-19 fear to encourage sick patients to seek emergency care. NEJM Catal Innov Care Deliv. May 14, 2020. Accessed March 6, 2022. https:\/\/catalyst.nejm.org\/doi\/full\/10.1056\/CAT.20.0193"},{"key":"hbr240007r11","unstructured":"American Heart Association. Fueled by COVID-19 fears, approximately half of Hispanics and Black Americans would fear going to the hospital if experiencing symptoms of a heart attack or stroke. July 23, 2020. 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