**1. Introduction**

Attention to the COVID-19 pandemic has strained the health care system globally, making it difficult to care for patients, especially the most vulnerable subgroups, such as people with acute diseases, including acute myocardial infarction (AMI). In particular, during the COVID-19 outbreak, AMI hospitalizations experienced a "drop" compared to pre-pandemic admission rates, a phenomenon observed worldwide [1,2].

The reasons for this finding are not entirely clear. For example, the decrease in air pollution levels due to quarantine measures may have played a role, although a true decrease in acute cardiac events appears very unlikely [1,2]. Instead, greater patient concern about a referral to hospital emergency departments was suggested as a critical reason for the decline in AMI admissions [1,2]. Of note, AMI patients may present a delayed time from the onset of symptoms to the first medical contact due to the fear of a possible in-hospital infection, as found in Italian and Chinese patients by us and by other researchers [2,3]. As a result, these patients may have a more severe infarction and more complications.

During the COVID-19 outbreak, specific psychometric tools were developed and validated to assess COVID-19 fear [4,5]. In particular, the Fear of COVID-19 Scale (FCV-19S), obtained from a seven-item questionnaire (total score between 7 and 35, a higher sum score indicating greater fear of COVID-19), was validated and applied in different general populations (both Asian and European), and showed significant associations of fear with stress, anxiety, and depression, as assessed by specific validated questionnaires (e.g., Hospital

**Citation:** Marotta, M.; Gorini, F.; Parlanti, A.; Chatzianagnostou, K.; Mazzone, A.; Berti, S.; Vassalle, C. Fear of COVID-19 in Patients with Acute Myocardial Infarction. *Int. J. Environ. Res. Public Health* **2021**, *18*, 9847. https://doi.org/10.3390/ ijerph18189847

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 26 July 2021 Accepted: 16 September 2021 Published: 18 September 2021

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Anxiety and Depression Scale, Perceived Vulnerability to Disease Scale) [4,6,7]. As for the Italian population, the FCV-19S was previously validated in a cohort of 249 participants (age 18 to 76 years), showing significant and positive correlations with the Hospital Anxiety and Depression Scale (HADS, r = 0.649) and Severity Measure for Specific Phobia—Adult (SMSP-A, r = 0.703) [8]. A study in a large Chinese general population found an elevated level of stress, anxiety, and depression (8.1%, 28.8%, and 16.5%, respectively) during the COVID-19 epidemic, and it remained unchanged at the outbreak peak, four weeks later [9]. Likewise, approximately 25% of 7,143 Chinese students experienced anxiety during the COVID-19 outbreak [10]. As FCV-19S was administered almost exclusively in general populations, it is interesting to study its results in patients, especially CV individuals, where mood alterations and/or lockdown can worsen lifestyle habits, cause poor adherence to therapy, avoidance of regular checks for stable CVD patients, and delays in hospital access in case of acute events [11]. Accordingly, we previously reported preliminary data obtained through the administration of the FCV-19S questionnaire in CV outpatients during the first pandemic wave, comparing their results with those published relatively to the general Italian population, evidencing higher scores in CV risk patients for both emotional (item 4) and symptomatic fear expression (items 3 and 6) [2,8].The main aim of this study was to evaluate the effect of the COVID pandemic on fear of COVID in patients with AMI through the administration of FCV-19S. Moreover, to identify possible differences between stable and acute patients, FCV-19S scores were evaluated in CV outpatients and in AMI patients.
