Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction.
Identifieur interne : 001911 ( Main/Corpus ); précédent : 001910; suivant : 001912Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction.
Auteurs : Chun Shing Kwok ; Chris P. Gale ; Tim Kinnaird ; Nick Curzen ; Peter Ludman ; Evan Kontopantelis ; Jianhua Wu ; Tom Denwood ; Nadeem Fazal ; John Deanfield ; Mark A. De Belder ; Mamas MamasSource :
- Heart (British Cardiac Society) [ 1468-201X ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Betacoronavirus (MeSH), COVID-19 (MeSH), Communicable Disease Control (MeSH), Coronavirus Infections (epidemiology), England (MeSH), Female (MeSH), Hospital Mortality (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Percutaneous Coronary Intervention (statistics & numerical data), Pneumonia, Viral (epidemiology), Procedures and Techniques Utilization (MeSH), Retrospective Studies (MeSH), SARS-CoV-2 (MeSH), ST Elevation Myocardial Infarction (diagnosis), ST Elevation Myocardial Infarction (mortality), ST Elevation Myocardial Infarction (therapy), Time-to-Treatment (MeSH), Treatment Outcome (MeSH).
- MESH :
- geographic : England.
- diagnosis : ST Elevation Myocardial Infarction.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- mortality : ST Elevation Myocardial Infarction.
- statistics & numerical data : Percutaneous Coronary Intervention.
- therapy : ST Elevation Myocardial Infarction.
- Aged, Betacoronavirus, COVID-19, Communicable Disease Control, Female, Hospital Mortality, Humans, Male, Middle Aged, Pandemics, Procedures and Techniques Utilization, Retrospective Studies, SARS-CoV-2, Time-to-Treatment, Treatment Outcome.
Abstract
BACKGROUND
The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.
METHODS
We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.
RESULTS
A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).
CONCLUSIONS
Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.
DOI: 10.1136/heartjnl-2020-317650
PubMed: 32868280
Links to Exploration step
pubmed:32868280Le document en format XML
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<author><name sortKey="Fazal, Nadeem" sort="Fazal, Nadeem" uniqKey="Fazal N" first="Nadeem" last="Fazal">Nadeem Fazal</name>
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<author><name sortKey="Deanfield, John" sort="Deanfield, John" uniqKey="Deanfield J" first="John" last="Deanfield">John Deanfield</name>
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<author><name sortKey="De Belder, Mark A" sort="De Belder, Mark A" uniqKey="De Belder M" first="Mark A" last="De Belder">Mark A. De Belder</name>
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<author><name sortKey="Kinnaird, Tim" sort="Kinnaird, Tim" uniqKey="Kinnaird T" first="Tim" last="Kinnaird">Tim Kinnaird</name>
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<affiliation><nlm:affiliation>Department of Cardiology, University Hospital of Wales, Cardiff, UK.</nlm:affiliation>
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<author><name sortKey="Curzen, Nick" sort="Curzen, Nick" uniqKey="Curzen N" first="Nick" last="Curzen">Nick Curzen</name>
<affiliation><nlm:affiliation>Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.</nlm:affiliation>
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<author><name sortKey="Ludman, Peter" sort="Ludman, Peter" uniqKey="Ludman P" first="Peter" last="Ludman">Peter Ludman</name>
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<author><name sortKey="Kontopantelis, Evan" sort="Kontopantelis, Evan" uniqKey="Kontopantelis E" first="Evan" last="Kontopantelis">Evan Kontopantelis</name>
<affiliation><nlm:affiliation>Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Wu, Jianhua" sort="Wu, Jianhua" uniqKey="Wu J" first="Jianhua" last="Wu">Jianhua Wu</name>
<affiliation><nlm:affiliation>Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Denwood, Tom" sort="Denwood, Tom" uniqKey="Denwood T" first="Tom" last="Denwood">Tom Denwood</name>
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<affiliation><nlm:affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Deanfield, John" sort="Deanfield, John" uniqKey="Deanfield J" first="John" last="Deanfield">John Deanfield</name>
<affiliation><nlm:affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="De Belder, Mark A" sort="De Belder, Mark A" uniqKey="De Belder M" first="Mark A" last="De Belder">Mark A. De Belder</name>
<affiliation><nlm:affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Mamas, Mamas" sort="Mamas, Mamas" uniqKey="Mamas M" first="Mamas" last="Mamas">Mamas Mamas</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>Communicable Disease Control (MeSH)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>England (MeSH)</term>
<term>Female (MeSH)</term>
<term>Hospital Mortality (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Percutaneous Coronary Intervention (statistics & numerical data)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Procedures and Techniques Utilization (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>ST Elevation Myocardial Infarction (diagnosis)</term>
<term>ST Elevation Myocardial Infarction (mortality)</term>
<term>ST Elevation Myocardial Infarction (therapy)</term>
<term>Time-to-Treatment (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>England</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>ST Elevation Myocardial Infarction</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>ST Elevation Myocardial Infarction</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Percutaneous Coronary Intervention</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>ST Elevation Myocardial Infarction</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Betacoronavirus</term>
<term>COVID-19</term>
<term>Communicable Disease Control</term>
<term>Female</term>
<term>Hospital Mortality</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Procedures and Techniques Utilization</term>
<term>Retrospective Studies</term>
<term>SARS-CoV-2</term>
<term>Time-to-Treatment</term>
<term>Treatment Outcome</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32868280</PMID>
<DateCompleted><Year>2020</Year>
<Month>11</Month>
<Day>25</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>12</Month>
<Day>18</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1468-201X</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>106</Volume>
<Issue>23</Issue>
<PubDate><Year>2020</Year>
<Month>12</Month>
</PubDate>
</JournalIssue>
<Title>Heart (British Cardiac Society)</Title>
<ISOAbbreviation>Heart</ISOAbbreviation>
</Journal>
<ArticleTitle>Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction.</ArticleTitle>
<Pagination><MedlinePgn>1805-1811</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1136/heartjnl-2020-317650</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.</AbstractText>
<AbstractText Label="METHODS">We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.</AbstractText>
<AbstractText Label="RESULTS">A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).</AbstractText>
<AbstractText Label="CONCLUSIONS">Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.</AbstractText>
<CopyrightInformation>© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kwok</LastName>
<ForeName>Chun Shing</ForeName>
<Initials>CS</Initials>
<Identifier Source="ORCID">0000-0001-7047-1586</Identifier>
<AffiliationInfo><Affiliation>Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gale</LastName>
<ForeName>Chris P</ForeName>
<Initials>CP</Initials>
<AffiliationInfo><Affiliation>Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kinnaird</LastName>
<ForeName>Tim</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Cardiology, University Hospital of Wales, Cardiff, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Curzen</LastName>
<ForeName>Nick</ForeName>
<Initials>N</Initials>
<Identifier Source="ORCID">0000-0001-9651-7829</Identifier>
<AffiliationInfo><Affiliation>Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ludman</LastName>
<ForeName>Peter</ForeName>
<Initials>P</Initials>
<Identifier Source="ORCID">0000-0002-7237-0946</Identifier>
<AffiliationInfo><Affiliation>Institute of Cardiovascular Sciences, Queen Elizabeth Hospital Birmingham, Birmingham, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kontopantelis</LastName>
<ForeName>Evan</ForeName>
<Initials>E</Initials>
<Identifier Source="ORCID">0000-0001-6450-5815</Identifier>
<AffiliationInfo><Affiliation>Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wu</LastName>
<ForeName>Jianhua</ForeName>
<Initials>J</Initials>
<Identifier Source="ORCID">0000-0001-6093-599X</Identifier>
<AffiliationInfo><Affiliation>Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Denwood</LastName>
<ForeName>Tom</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>NHS Digital, Leeds, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Fazal</LastName>
<ForeName>Nadeem</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Deanfield</LastName>
<ForeName>John</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>de Belder</LastName>
<ForeName>Mark A</ForeName>
<Initials>MA</Initials>
<AffiliationInfo><Affiliation>National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Mamas</LastName>
<ForeName>Mamas</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK mamasmamas1@yahoo.co.uk.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>08</Month>
<Day>31</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>England</Country>
<MedlineTA>Heart</MedlineTA>
<NlmUniqueID>9602087</NlmUniqueID>
<ISSNLinking>1355-6037</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>AIM</CitationSubset>
<CitationSubset>IM</CitationSubset>
<CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Heart. 2020 Dec;106(23):1786-1787</RefSource>
<PMID Version="1">33087411</PMID>
</CommentsCorrections>
</CommentsCorrectionsList>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D003140" MajorTopicYN="Y">Communicable Disease Control</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D004739" MajorTopicYN="N" Type="Geographic">England</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D062645" MajorTopicYN="N">Percutaneous Coronary Intervention</DescriptorName>
<QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000078337" MajorTopicYN="N">Procedures and Techniques Utilization</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000072657" MajorTopicYN="N">ST Elevation Myocardial Infarction</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D061665" MajorTopicYN="N">Time-to-Treatment</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">acute myocardial infarction</Keyword>
<Keyword MajorTopicYN="Y">percutaneous coronary intervention</Keyword>
</KeywordList>
<CoiStatement>Competing interests: None declared.</CoiStatement>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year>
<Month>06</Month>
<Day>23</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised"><Year>2020</Year>
<Month>08</Month>
<Day>04</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted"><Year>2020</Year>
<Month>08</Month>
<Day>07</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed"><Year>2020</Year>
<Month>9</Month>
<Day>2</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline"><Year>2020</Year>
<Month>11</Month>
<Day>26</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez"><Year>2020</Year>
<Month>9</Month>
<Day>2</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">32868280</ArticleId>
<ArticleId IdType="pii">heartjnl-2020-317650</ArticleId>
<ArticleId IdType="doi">10.1136/heartjnl-2020-317650</ArticleId>
</ArticleIdList>
</PubmedData>
</pubmed>
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