Primary care for patients with coronary heart disease during the COVID-19 pandemic in Germany

Anne Schrimpf, Nathalie Mähl, Stefan Lippmann, Tobias Deutsch, Markus Bleckwenn

To reduce the risk of infection with COVID-19 in high-risk populations, interventions in the disease management program (DMP) for coronary heart disease (CHD) could have been suspended. Clinical data showed a decrease of acute myocardial infarction (AMI) cases since March 2020 but an increase of severe AMI cases, indicating that symptomatic patients might have suspended/delayed a hospital visit during the pandemic. Data on the extent and impact of delayed primary care for DMP-CHD-patients is absent.

Research questions:
We investigate if the coronavirus pandemic affect primary care for DMP-CHD patients.

The data were collected in Germany between 10/2020 - 01/2021. In total, 20 GPs agreed on participation and completed a questionnaire. 1295 DMP-CHD patients have been recruited and received a patient questionnaire. 745 patients returned the questionnaire to date. The patient questionnaire assessed demographics, health behavior, medical history, dealing with risk of infection, consultation of medical services and CHD-symptoms during the epidemic, and psychological well-being.

427 questionnaires were analyzed (mean age: 74,1 years; 29 % female). GPs reported no reduction in DMP-CHD appointments in the 1. and 2. quarter of 2020 compared to 2019. Patients that suspended DMP-CHD appointments reported fear of getting infected with COVID-19 as a main reason. Since March 2020, 11,2 % of the patients reported CHD-related symptoms. These patients exhibited higher state depression scores compared to patients without symptoms. Importantly, of patients with CHD-related symptoms, 31,3 % did not consult a medical specialist. They reported being more concerned about the coronavirus than patients that consulted a medical specialist.

The study is ongoing. Our results obtained to date suggest that sufficient medical care for patients with CHD has been provided during the COVID-19 pandemic. The fear of infection with COVID-19 might facilitate the CHD-patients’ decision not to consult a medical doctor. A correlation between depressive and CHD-related symptoms was observed.

Points for discussion:
How can we use the results of the study to improve primary care for high-risk populations with chronic diseases in the second year of the pandemic?

Compared to previous years, is there any evidence/available data that CHD-related symptoms increased in 2020?

Since the outbreak of the pandemic, did you observe an increasing percentage of patients who did not visit a specialist despite having CHD-related symptoms?