Cardiovascular Deaths During the COVID-19 Pandemic in the United States

Wadhera, Rishi K.; Shen, Changyu; Gondi, Suhas; Chen, Siyan; Kazi, Dhruv S.; Yeh, Robert W.

doi:10.1016/j.jacc.2020.10.055

Cited by 171 publications

(152 citation statements)

References 21 publications

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“…Thus, discriminating between the effects of acute MI and acute COVID-19 infection remains a significant challenge. However, the results from our International COVID-ACS Registry go further than previous studies and provide novel insights to support a hypothesis of potential COVID-19 fear and a consequent reluctance to go to hospital, a reluctance that appears to have led to an increase in deaths from ischemic heart disease during the pandemic ( 26 ). This multicomorbid population presented to hospitals significantly later and received less timely reperfusion therapy, thereby resulting in significantly higher rates of CGS and in-hospital mortality.…”

Section: Discussionmentioning

confidence: 60%

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

Kite

Ludman

Gale

et al. 2021

Journal of the American College of Cardiology

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Background Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. Objectives The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts. Methods From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). Results In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). Conclusions In this multicenter international registry, COVID-19–positive ACS patients presented later and had increased in-hospital mortality compared with a pre–COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.

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Section: Discussionmentioning

confidence: 60%

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

Kite

Ludman

Gale

et al. 2021

Journal of the American College of Cardiology

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“…Eleven of the 12 studies reported mostly an increase in stroke hospitalisations during the pandemic period compared to the pre-pandemic period or observed no changes. In the single study by Wadhera et al which evaluated CVD deaths in the USA [ 15 ], deaths caused by ischemic heart disease and hypertensive disease increased nationally after the onset of the pandemic in 2020, compared with changes over the same period in 2019, but not for HF, cerebrovascular disease, or other diseases of the circulatory system.…”

Section: Resultsmentioning

confidence: 99%

Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: A systematic review

Seidu

Kunutsor

Cos

et al. 2021

Primary Care Diabetes

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Background The Coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic crisis in health care systems worldwide. These may have significant implications for the management of cardiometabolic diseases. We conducted a systematic review of published evidence to assess the indirect impact of the COVID-19 pandemic on hospitalisations for cardiovascular diseases and their management. Methods Studies that evaluated volume of hospitalisations for cardiometabolic conditions and their management with comparisons between the COVID-19 and pre-COVID periods were identified from MEDLINE, Embase and the reference list of relevant studies from January 2020 to 25 February 2021. Results We identified 103 observational studies, with most studies assessing hospitalisations for acute cardiovascular conditions such as acute coronary syndrome, ischemic strokes and heart failure. About 89% of studies reported a decline in hospitalisations during the pandemic compared to pre-pandemic times, with reductions ranging from 20.2 to 73%. Severe presentation, less utilization of cardiovascular procedures, and longer patient- and healthcare-related delays were common during the pandemic. Most studies reported shorter length of hospital stay during the pandemic than before the pandemic (1–8 vs 2–12 days) or no difference in length of stay. Most studies reported no change in in-hospital mortality among hospitalised patients. Conclusion Clinical care of patients for acute cardiovascular conditions, their management and outcomes have been adversely impacted by the COVID-19 pandemic. Patients should be educated via population-wide approaches on the need for timely medical contact and health systems should put strategies in place to provide timely care to patients at high risk. Systematic review registration PROSPERO 2021: CRD42021236102

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confidence: 99%

Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges

Solomon

Nguyen‐Huynh

Leong

et al. 2021

JAMA

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Early during the COVID-19 pandemic, marked declines in patients presenting with acute cardiovascular conditions were observed, 1,2 whereas mortality attributed to cardiovascular causes increased. 3 This raised concerns that patient reluctance to seek emergency care contributed to preventable complications and excess deaths, and public health campaigns sought to reassure patients that hospitals were safe and to encourage seeking care when needed. As COVID-19 resurged in late 2020, rates of infections, hospitalizations, and deaths exceeded those of previous surges. Many countries reimplemented lockdowns, and recent UK data indicate that presentations for emergent cardiovascular conditions again declined. 4 We evaluated changes in rates of acute myocardial infarction (AMI) hospitalizations and suspected ischemic stroke as measures of patient willingness to seek emergency care during the most recent COVID-19 surges in the US.Methods | We examined data from Kaiser Permanente Northern California (KPNC), a large, integrated health care delivery system with 21 medical centers and 255 clinics, providing comprehensive care for more than 4.5 million persons throughout Northern California. Its membership is highly representative of the local and statewide population regarding age, sex, race and ethnicity, and socioeconomic status. 5 We examined weekly incidence rates for adult members hospitalized for AMI or suspected acute ischemic stroke (ie, "stroke alerts") who presented to KPNC facilities from January 22, 2019, to January 18, 2021. Acute MI was identified with a combination of discharge diagnosis codes and positive values of serum cardiac troponin I. 1 Stroke alerts are tracked through a comprehensive stroke program at 21 Joint Commission stroke-certified KPNC facilities that includes immediate consultation by neurologists for evaluation and treatment for all suspected ischemic strokes. 2,6 We excluded patients younger than 18 years, with unknown sex, or with lack of active health plan membership in each weekly cohort.Weekly incidence rates of events per 100 000 personweeks and 95% CIs for AMI and stroke alerts during COVID-19 periods (

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Cardiovascular Deaths During the COVID-19 Pandemic in the United States

Cited by 171 publications

References 21 publications

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: A systematic review

Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges

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