COVID-19 pandemic affects rates of patients in urgent CV care
Acute CV hospitalizations and cardiac catheterization laboratory activations have declined during the COVID-19 pandemic, two studies found.
“The findings underscore fundamental learnings about the collateral effects of the pandemic on society at large,” Ankeet S. Bhatt, MD, MBA, clinical fellow in the division of cardiology at Brigham and Women’s Hospital and Harvard Medical School, told Healio. “I wonder if entirely well-intentioned messaging surrounding stay-at-home measures may have been misinterpreted in context and led to patients not seeking care for acute cardiovascular conditions.”
Acute CV hospitalizations
In a study published in the Journal of the American College of Cardiology, Bhatt and colleagues analyzed data from 7,187 acute CV hospitalizations of 6,083 patients between 2019 and March 2020. Acute CV hospitalizations included stroke (n = 1,566), HF (n = 2,933), chest pain syndromes (n = 2,217) and other acute CV conditions (n = 471).
“This study stemmed from what we saw clinically — low volumes on inpatient cardiology services unlikely to be explained by deferral of elective care alone,” Bhatt said in an interview.
Several factors were compared before and after March 2020, such as length of stay, demographic characteristics, in-hospital mortality and discharge disposition.
The total number of CV hospitalizations declined by 43.4% from March 2019 to March 2020 (27.4% to 56%; P < .001).
“This is likely to be unaccounted for by environmental factors like less pollution and eating habits,” Bhatt told Healio. “There is strong rationale and consistent global findings that suggest acute cardiovascular care may have been delayed and deferred during the pandemic.”
Daily rates of CV hospitalizations did not significantly change during 2019 (0.01% per day), in January 2020 (0.5% per day) or in February 2020 (+0.7% per day). Daily CV admissions declined by 5.9% per day in March 2020 (P < .001).
Length of stay decreased from 5.7 days before March 2020 to 4.8 days after March 2020 (P = .001). This was also observed when compared with month-matched patients who were admitted in March 2019 (6 days to 4.8 days; P = .003).
Patients admitted in March 2020 had higher rates of in-hospital all-cause mortality compared with those admitted before March 2020, although it did not reach statistical significance (6.2% vs. 3.8%).
“We need to consider alternative messaging around being responsible to mitigate disease spreading including physical distancing, masks and hand hygiene,” Bhatt said in an interview. “We also need messaging supporting the notion that hospitals have adapted quickly and are safe places to seek non-COVID-related acute care. Patients should seek care if they are having serious symptoms.”
In a related editorial, Joseph E. Ebinger, MD, MS, faculty cardiologist and director of clinical analytics at Smidt Heart Institute at Cedars Sinai Medical Center, and Prediman K. Shah, MD, Shapell and Webb Family Chair in Clinical Cardiology, director of the Oppenheimer Atherosclerosis Research Center and of the Atherosclerosis Prevention and Management Center, and professor of medicine at Cedars Sinai, wrote: “The consequences of COVID-19 are not limited to those stricken with the virus, but include collateral damage to patients suffering from other diseases. Defeating COVID-19 will require a dramatic reshaping of care delivery, novel approaches to patient management and large-scale reallocation of resources.”
Cardiac catheterization laboratory activations
In a study published in The American Journal of Cardiology, Amanda L. Zaleski, PhD, clinical researcher in the department of preventive cardiology at Hartford Hospital, and colleagues analyzed activations of the cardiac catheterization laboratory for STEMI and non-ST segment elevation ACS. Activations were compared from December 2019 to April 2020 with the monthly average from 2015 to 2019.
“From initial onset, our team began closely monitoring secondary consequences of COVID-19,” Zaleski told Healio. “We initially predicted an uptick of acute cardiovascular events based on previous humanitarian emergencies, yet emerging anecdotal reports in early April indicated otherwise. We felt it was important to quantify this paradoxical reduction in acute cardiovascular events as it was largely anecdotal at the time.”
Compared with activations from 2015 to 2019, STEMI activations increased by 38% in February 2020 then decreased by 16% in March and 21% in April. Decreases in activations for non-ST segment elevation ACS were also observed in February (21%), March (37%) and April 2020 (80%).
“We are the first to describe a 38% increase in STEMI activations for February,” Zaleski said in an interview. “This is important because previous reports documenting reductions in post-COVID STEMI activations did not evaluate February activations separately, and thus reductions in March activations may be greatly underestimated. This increase immediately prior to the epidemic needs verification but may indicate an increase in events due to psychological stress during the recognition and/or initiation interval of the pandemic.”
Cardiac catheterization laboratory activations were completed for 140 patients (mean age, 63 years; 64% men) between February and April 2020. Three patients died during this time, of whom one delayed medical attention for approximately 24 hours due to fears of the COVID-19 infection.
From March to April 2020, the documented time from symptom onset to medical attention was an average of 75 hours.
“We have identified that there is a marked reduction in acute cardiovascular emergencies; however, we are still in the early stages of understanding these trends on a patient level,” Zaleski told Healio. “Intuitively, it is possible that acute CV complications have been masked by COVID-19-associated morbidity and mortality. It is possible that out-of-hospital arrests have increased, which require autopsies and centralized reporting. Lastly, we will continue to learn from the patients who present in the near future with regard to nature and magnitude of pre-hospital delay and associated outcomes.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.
References:
- Ebinger JE, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2020.05.039.
- Zaleski AL, et al. Am J Cardiol. 2020;doi:10.1016/j.amjcard.2020.05.029.
For more information:
Ankeet S. Bhatt, MD, MBA, can be reached at abhatt5@bwh.harvard.edu; Twitter: @ankeetbhatt.
Amanda L. Zaleski, PhD, can be reached at amanda.zaleski@hhchealth.org; Twitter: @amandazaleski.
Collapse
Read more about