Date of Award

2022-05-28

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; K. Sue Hoyt, PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN, Committee; Christian Alberto Tomaszewski, MD, MBA, FACEP, FACMT, Committee

Keywords

STEMI, NSTEMI, myocarditis, pericarditis, Atrial fibrillation, COVID-19

Abstract

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong cardiovascular sequelae. Currently, there is a paucity of data on the incidence and treatment of cardiac implications related to COVID-19. The purpose of this study is to identify the occurrence and management of pandemic-associated cardiac complications, specifically ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), atrial fibrillation (AF), myocarditis, pericarditis, and COVID status in a sample of adults, aged 18 years and older presenting with cardiac complications at a large, rural ED.

Theoretical/Conceptual Framework: Inflammatory cytokine response syndrome (i.e., cytokine storm) guided this study.

Approach/Method:. Retrospective descriptive correlational design. Data were extracted from the electronic health records (EHR) of patients presenting to the study hospital. Inclusion criteria: adults aged 18 and older, occurrence of cardiac complications, and documented COVID-19 status.

Results: Cardiac implications of the COVID-19 pandemic were noted to be frequent (χ2 = 203.74, p < .001, Phi = .811, very large effect size) with a risk of long term cardiac sequalae. The most common cardiac implications included NSTEMI (50.4%, n = 183) and AF (43.4%, n = 158). Implications of the COVID-19 pandemic were negatively associated with the standard of care, more so in COVID-19 negative patients than positive patients. This study revealed pivotal points for future research on the incidence and management of COVID-19 cardiac sequalae for highly underserved communities.

Keywords: STEMI, NSTEMI, myocarditis, pericarditis, AFib, COVID-19

Document Type

Dissertation: Open Access

Department

Nursing

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