Chest pain presentations to hospital during the COVID-19 lockdown: lessons for public health media campaigns

Abstract ObjectiveEmergency Department (ED) attendances with chest pain reduced during the COVID-19 lockdown. To understand factors influencing patients’ decisions to attend hospital, we performed a local service evaluation project in NHS Lothian. MethodsWe collated data on online searches and local clinical services on the number of ED presentations and chest pain clinic (CPC) referrals with suspected acute coronary syndrome between January and May 2020 and compared findings with the same period in 2019. We also carried out 28 semi-structured telephone interviews with patients who presented with chest pain during lockdown and in patients with known coronary heart disease under the outpatient care of a cardiologist in April and May 2020. Interviews were audio recorded and salient themes and issues documented as verbatim extracts. ResultsOnline searches for the term “chest pain” doubled after 01/03/2020, peaking in week commencing 22/03/2020 and returning to 2019 levels during April 2020. In contrast, chest pain presentations to ED and CPC decreased, with the greatest reduction in the final week of March 2020 (128 v 287 (average weekly ED attendance 2019), and 6 v 23 (average weekly CPC referral 2019)). This aligned with key government messages to ‘Protect the NHS’ and the ‘NHS is open’ campaign. Patient interviews revealed three main themes; 1) pandemic help-seeking behaviour2) COVID-19 exposure concerns; 3) favourable Hospital experience if admitted. ConclusionsDynamic monitoring of public health and media messaging should evaluate public response to healthcare campaigns to ensure the net impact on health, pandemic and non-pandemic related, is optimised. What is already known about the subject?Reports from around the world revealed a decrease in the numbers of patients attending hospital for serious health complaints such as chest pain during the lockdown restrictions imposed by governments to decrease the spread of SARS-CoV-2. What does this study add?This service evaluation project has provided insight into how patients experiencing chest pain made the decision to attend hospital for assessment during this period. It has revealed how the pandemic shaped help-seeking practices, how patients interpreted their personal vulnerability to the virus, and describes patient experience of attending hospital for assessment during this time. How might this impact on clinical practice?Careful monitoring of the public response to health care messaging campaigns should be a key part of a pandemic strategy and careful adjustment of messaging, in a dynamically responsive way, should be considered in future.