Systemic resilience: COVID-19 and healthcare quality in acute myocardial infarction at tertiary medical centers – a nationwide study from Taiwan

Authors

Shih-An Liu, Department of Otorhinolaryngology Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
Sheng-Hui Hung, Chief Executive Officer Office, 6 Division of Quality Improvement, Joint Commission of Taiwan, New Taipei, 22069, Taiwan
Chih-Hung Ku, School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan;
Yan-Ru Wang, Center for Quality Management, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
Ching-I Chang, Chief Executive Officer Office, 6 Division of Quality Improvement, Joint Commission of Taiwan, New Taipei, 22069, Taiwan
Pa-Chun Wang, Department of Quality Management, Cathay General Hospital, Taipei, 10630, Taiwan.Follow

Abstract

Background: The COVID-19 was a pandemic once in a century. This study aimed to review the quality of acute myocardial infarction (AMI) care during the COVID-19 pandemic from a national perspective.

Methods: A retrospective analysis was conducted using Joint Commission of Taiwan (JCT)’s national Taiwan Clinical Performance Indicator (TCPI) system AMI care data, in correlation with Taiwan Centers for Disease Control COVID-19 epidemiological information. The time frames of the current study were categorized into four periods, based on the four levels of epidemic prevention and response established by the Central Epidemic Command Center (CECC). Quality indicators among different periods were compared and Statistical Process Control (SPC) charts were illustrated.

Results: The incidences of AMI remained stable along the pandemic years. However, there was a significant drop of ST-segment elevated MI cases. The percutaneous coronary intervention performance (< 90 minutes upon arrival) for northern hospitals was significantly affected (second quarter of 2021) initially yet quickly recovered after second quarter of 2022. The in-hospital mortality of AMI patients was lower during the COVID-19 pandemic, especially in southern Taiwan. The CECC endeavored to secure healthcare capacity and continuously adapted strategies during the pandemic.

Conclusion: Systemic resilience in healthcare systems is important as it will facilitate efforts to cope with emerging contagious diseases in the future. Interjurisdictional coordination including public health sectors, human service department, and healthcare systems is essential as well as adequate funding to maintain systemic resilience and better preparation for forthcoming events.

Keywords: Resilience, COVID-19, Myocardial Infarction, Quality of Health Care

Recommended Citation

Liu S, Hung S, Ku C, Wang Y, Chang C, Wang P. Systemic resilience: COVID-19 and healthcare quality in acute myocardial infarction at tertiary medical centers – a nationwide study from Taiwan. J Health Res. 2025; 39(5):-. DOI: https://doi.org/10.56808/2586-940X.1161

References

[1] Erol MK, Kayıkçıoglu M, Kılıçkap M, Güler A, YıldırımA, KahramanF,et al. Treatment delays and in-hospital outcomes inacutemyocardialinfarctionduringtheCOVID-19pandemic: A nationwide study. Anatol J Cardiol 2020 Nov;24(5):334e42. https://doi.org/10.14744/AnatolJCardiol.2020.98607.

[2] Liu SA, Wu CL, Chou IJ, Wang PC, Hsu CL, Chen CP. The impacts of COVID-19 on healthcare quality in tertiary medical centers-a retrospective study on data from Taiwan clinical performance indicators system. Int J Environ Res Publ Health 2022 Feb 17;19(4):2278. https://doi.org/10.3390/ijerph19042278.

[3] Konig S, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A, et al. In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network. Eur J Heart Fail 2020 Dec;22(12):2190e201. https://doi.org/10.1002/ejhf.2044.

[4] Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, et al. Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic. Cardiovasc Interv Ther 2022 Oct;37(4):641e50. https://doi.org/10.1007/s12928-022-00836-4.

[5] Ma T, Huang Y, Li W, Zhong J, Yang H, Zhou Y, et al. The number of patients with acute myocardial infarction decreased and door-to-balloon time delayed in COVID-19. Cardiol Res Pract 2021 Mar 25;2021:6673313. https://doi.org/10.1155/2021/6673313.

[6] Chew NW, Sia CH, Wee HL, Benedict LJ, Rastogi S, Kojodjojo P, et al. Impact of the COVID-19 pandemic on door-to-balloon time for primary percutaneous coronary intervention e results from the Singapore Western STEMI Network. Circ J 2021 Jan 25;85(2):139e49. https://doi.org/10.1253/circj.CJ-20-0800.

[7] Yeo YH, WangM,HeX,LvF,ZhangY,ZuJ,etal.Excessrisk for acute myocardial infarction mortality during the COVID19 pandemic. J Med Virol 2023 Jan;95(1):e28187. https://doi.org/10.1002/jmv.28187.

[8] Shaka H, Ilelaboye AI, DeAngelo S, Gwira-Tamattey E, Vardar U. Increased national mortality in acute myocardial infarction hospitalization during the COVID-19 pandemic. Proc (Bayl Univ Med Cent) 2023 Jan 30;36(3):298e303. https://doi.org/10.1080/08998280.2023.2169557.

[9] Primessnig U, Pieske BM, Sherif M. Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID-19 pandemic. ESC Heart Fail 2021 Feb;8(1): 333e43. https://doi.org/10.1002/ehf2.13075.

[10] Smaggus A, Long JC, Ellis LA, Clay-Williams R, Braithwaite J. Government actions and their relation to resilience in healthcare during the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Int J Health Pol Manag 2022 Sep 1;11(9):1682e94. https://doi.org/10.34172/ijhpm.2021.67.

[11] Witter S, Thomas S, Topp SM,Barasa E, Chopra M, CobosD, et al. Health system resilience: a critical review and reconceptualisation. Lancet Global Health 2023 Sep;11(9):e1454e8. https://doi.org/10.1016/S2214-109X(23)00279-6.

[12] Hsu CL, Hung SH, Munkhtogoo D, Wang PC. The impact of the COVID-19 pandemic on emergency care of acute myocardial infarction: findings from the Taiwan Clinical Performance Indicator. Int J Qual Health Care 2023 Jun 6; 35(2):mzad034. https://doi.org/10.1093/intqhc/mzad034.

[13] Su YJ. COVID-19 outbreak in Taiwan: Spring 2022. Asia Pac J Publ Health 2023 Nov;35(8):561e3. https://doi.org/10.1177/10105395231203117.

[14] Taiwan Centers for Disease Control, Ministry of Health and Welfare. Open Data Portal. [cited 2024 Apr]. Available from: https://data.cdc.gov.tw/en/dataset/?tags¼%E5%86%A0% E7%8B%80%E7%97%85%E6%AF%92.

[15] Chew NWS, Ow ZGW, Teo VXY, Heng RRY, Ng CH, Lee CH, et al. The global effect of the COVID-19 pandemic on STEMI Care: a systematic review and meta-analysis. Can J Cardiol 2021 Sep;37(9):1450e9. https://doi.org/10.1016/j.cjca.2021.04.003.

[16] Foo CY, Bonsu KO,Nallamothu BK,Reid CM,DhippayomT, Reidpath DD, et al. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart 2018 Aug;104(16):1362e9. https://doi.org/10.1136/heartjnl-2017-312517.

[17] Pourasghari H, Tavolinejad H, Soleimanpour S, Abdi Z, Arabloo J, Bragazzi NL, et al. Hospitalization, major complications and mortality in acute myocardial infarction patients during the COVID-19 era: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2022 May 23;41: 101058. https://doi.org/10.1016/j.ijcha.2022.101058.

[18] Lee SYA, Loh PH, Lau YH, Jiang Y, Liew BW, Lim PZY, Rastogi S, Tan WCJ, Ho HH, Yeo KK. Impact of COVID-19 pandemic early response measures on myocardial infarctions and acute cardiac care in Singapore. Int J Qual Health Care 2023 Jun 1;35(2):mzad023. https://doi.org/10.1093/intqhc/mzad023.

[19] Lu JR, Chiang TL. Developing an adequate supply of health services: Taiwan's path to Universal Health Coverage. Soc Sci Med 2018 Feb;198:7e13. https://doi.org/10.1016/j.socscimed.2017.12.017.

[20] Wang VY. Systemic resilience and COVID-19: lessons from Taiwan. Int J Qual Health Care 2022 Apr 25;34(2):mzac029. https://doi.org/10.1093/intqhc/mzac029.

[21] Lin C, Braund WE,AuerbachJ, ChouJH,TengJH,TuP,etal. Policy decisions and use of information technology to fight COVID-19, Taiwan. Emerg Infect Dis 2020 Jul;26(7):1506e12. https://doi.org/10.3201/eid2607.200574.

[22] Martin CM. Resilience and health (care): a dynamic adaptive perspective. J Eval Clin Pract 2018 Dec;24(6):1319e22. https://doi.org/10.1111/jep.13043.

[23] Adjei S, Hong K, Molinari NM, Bull-Otterson L, Ajani UA, Gundlapalli AV, et al. Mortality risk among patients hospitalized primarily for COVID-19 during the omicron and delta variant pandemic periods- United States, April 2020-June 2022. MMWR Morb Mortal Wkly Rep 2022 Sep 16;71(37): 1182e9. https://doi.org/10.15585/mmwr.mm7137a4.