Objective To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic. Design Nationwide, population based cohort study. Setting Denmark from 13 March 2019 to 27 January 2021. Participants All Danish residents >1 year of age. Main outcomes measures Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk. Results 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods. Conclusions Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.

E ach year, >1 000 000 Americans experience acute myocardial infarction (AMI) or acute ischemic stroke (AIS). 1 Any role of acute infection in triggering acute cardiovascular events is of major clinical and public health interest. [2][3][4][5] Infections may increase the risk of AMI and AIS 6-14 by inducing demand ischemia, decreasing myocardial contractility, or causing endothelial dysfunction, coagulation disturbance, or direct platelet activation. [2][3][4][15][16][17][18] The magnitude and duration of the increased cardiovascular risk is debatable. Cohort studies have reported short-term risks of AMI and stroke varying from 0.2% to >10% after patients have been hospitalized with pneumonia, sepsis, endocarditis, or meningitis. [7][8][9][10][11][19][20][21] Editorial see p 1375 Clinical Perspective on p 1396Case-only studies suggest a 10-to 50-fold increased risk for AMI or stroke shortly after patients have been hospitalized with infection, 6,9,12 and a 2-to 5-fold increased risk shortly after infection diagnosed by general practitioners. 13,14 Only 1 cohort study of 206 patients with pneumonia included a comparison group, 9 and we are aware of only 3 studies that included microbiological test results. 6,9,10 The lack of laboratory confirmation of infection may have falsely inflated the effect estimates if cardiovascular events were initially misdiagnosed as infections. Community-acquired bacteremia (CAB) is a well-defined clinical entity that embraces a wide range of mechanisms whereby infection may trigger cardiovascular events. We conducted a 20-year population-based cohort study in Denmark to assess the short-and longer-term risks of AMI and AIS among medical patients with CAB in Background-Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia. Methods and Results-Thispopulation-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI,) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days aft...

CorrespondenceWe thank Khan and Moukarbel for their interest in our study concerning the risk of myocardial infarction (MI) and ischemic stroke after community-acquired bacteremia. 1 We agree that recent MI/stroke is a risk factor for infection and a potential confounder of the association between bacteremia and new-onset MI/stroke. To account for this potential confounding, we adjusted for previous MI and stroke in multivariable analyses. In addition, we stratified analyses by the presence of any previous MI, any previous stroke, and any previous cardiovascular disease. In these analyses, bacteremia remained associated with MI/stroke.We also agree that residual and unmeasured confounding may account for some of the increased risk of a thromboembolic event associated with bacteremia. Although our analyses do not fully establish causation, we believe that future well-conducted, observational study designs are the only possible way to study the association between severe infection and cardiovascular risk in humans. DisclosuresNone. Michael Dalager-Pedersen, MD, PhDDepartment

Background Venous thromboembolism (VTE) is a potentially fatal complication of SARS-CoV-2 infection and thromboprophylaxis should be balanced against risk of bleeding. This study aimed to examine risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations. Methods Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at six departments of infectious diseases in Denmark were reviewed in detail. Results The overall 30-day risk of VTE was 0.4% (40/9,460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226,510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16,281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9,460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding. Conclusions Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.