{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:08:16Z","timestamp":1775099296436,"version":"3.50.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,7,18]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Cardiovascular procedural treatments were deferred at scale during the COVID\u201019 pandemic, with unclear impact on patients presenting with non\u2013ST\u2010segment\u2013elevation myocardial infarction (NSTEMI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In a retrospective cohort study of all patients diagnosed with NSTEMI in the US Veterans Affairs Healthcare System from January 1, 2019 to October 30, 2022 (n=67\u2009125), procedural treatments and outcomes were compared between the prepandemic period and 6 unique pandemic phases: (1) acute phase, (2) community spread, (3) first peak, (4) post vaccine, (5) second peak, and (6) recovery. Multivariable regression analysis was performed to assess the association between pandemic phases and 30\u2010day mortality. NSTEMI volumes dropped significantly with the pandemic onset (62.7% of prepandemic peak) and did not revert to prepandemic levels in subsequent phases, even after vaccine availability. Percutaneous coronary intervention and coronary artery bypass grafting volumes declined proportionally. Compared with the prepandemic period, patients with NSTEMI experienced higher 30\u2010day mortality during Phases 2 and 3, even after adjustment for COVID\u201019\u2010positive status, demographics, baseline comorbidities, and receipt of procedural treatment (adjusted odds ratio for Phases 2 and 3 combined, 1.26 [95% CI, 1.13\u20131.43],\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). Patients receiving Veterans Affairs\u2010paid community care had a higher adjusted risk of 30\u2010day mortality compared with those at Veterans Affairs hospitals across all 6 pandemic phases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Higher mortality after NSTEMI occurred during the initial spread and first peak of the pandemic but resolved before the second, higher peak\u2014suggesting effective adaptation of care delivery but a costly delay to implementation. Investigation into the vulnerabilities of the early pandemic spread are vital to informing future resource\u2010constrained practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.029910","type":"journal-article","created":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T07:22:39Z","timestamp":1688800959000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Myocardial Infarction Across COVID\u201019 Pandemic Phases: Insights From the Veterans Health Affairs System"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3054-6576","authenticated-orcid":false,"given":"Celina M.","family":"Yong","sequence":"first","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Division of Cardiovascular Medicine Stanford University School of Medicine, and Cardiovascular Institute Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7327-3793","authenticated-orcid":false,"given":"Laura","family":"Graham","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center (HERC), VA Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Stanford\u2010Surgery Policy Improvement Research &amp; Education Center (S\u2010SPIRE) Stanford Medicine Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7474-1966","authenticated-orcid":false,"given":"Tariku J.","family":"Beyene","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirin","family":"Sadri","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliette","family":"Hong","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Burdon","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1799-1368","authenticated-orcid":false,"given":"William F.","family":"Fearon","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Division of Cardiovascular Medicine Stanford University School of Medicine, and Cardiovascular Institute Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M.","family":"Asch","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Department of Medicine Stanford School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-0904","authenticated-orcid":false,"given":"Mintu","family":"Turakhia","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Division of Cardiovascular Medicine Stanford University School of Medicine, and Cardiovascular Institute Stanford CA USA"},{"name":"Center for Digital Health Stanford University Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-8490","authenticated-orcid":false,"given":"Paul","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Healthcare System Palo Alto CA USA"},{"name":"Division of Cardiovascular Medicine Stanford University School of Medicine, and Cardiovascular Institute Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"Veterans Health Administration\u2013Office of Emergency Management . 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