Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic

Abstract

Background This study sought to determine the impact of the pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease. Methods This is a population-based cohort study performed in the province of Nova Scotia (population 979,499), between Pre-COVID (March 1, 2017 – March 16, 2020) and in-COVID (March 17, 2020 – December 31, 2020) periods. Adult patients (≥18 years) with new onset or existing cardiovascular disease were included for comparison between periods. The main outcome measures included: cardiovascular emergency department visits or hospitalizations, mortality, and out-of-hospital cardiac arrest. Results In the first month of the in-COVID period, emergency department visits (n=51,750) for cardiac symptoms decreased by 20.8% (95% CI 14.0% - 27.0%, p<0.001). Cardiovascular hospitalizations (n=20 609) declined by 48.1% (95% CI 40.4% to 54.9%, p<0.001). In-hospital mortality rate increased in patients with cardiovascular admissions in secondary care institutions by 55.1% (95%CI 10.1%-118%, p=0.013). A decline of 20.4% - 44.0% occurred in cardiovascular surgical/interventional procedures. Out-of-hospital cardiac arrests (n=5528) increased from a monthly mean of 115±15 to 136±14, beginning in May, 2020. Mortality for ambulatory patients awaiting cardiac intervention (n=14,083) increased from 0.16% (n=12501) to 2.49% (n=361) in the in-COVID period (p<0.0001). Conclusion This study demonstrates increased cardiovascular morbidity and mortality during restrictions maintained during COVID-19, in an area with low burden of COVID-19 disease. As the healthcare system recovers or enters subsequent waves of COVID-19, these findings should inform communication to the public regarding cardiovascular symptoms and policy for delivery of cardiovascular care.

Cardiac arrest and coronavirus disease 2019

“…In Europe, data from Paris area [ 8 ▪ ] reported a 2-fold increase in OHCA incidence immediately before and during the weeks after Paris lockdown; similarly in England, both in London [ 9 ▪ ] and in North East England [ 10 ] where an increase in OHCA incidence strongly correlated with the daily number of COVID-19 cases was noticed in March–April 2020. Moving to America, an increase in OHCA during the first pandemic wave was pointed out not only in New York City, the most important USA outbreak of COVID-19 during the first wave, where a 3-fold increase in OHCA was highlighted [ 11 ▪ , 12 ], but in also in areas other than the United States of America [ 13 – 16 , 17 ▪▪ ], as in Canada [ 18 ] and in Brazil [ 19 ]. A slight increase was observed also in some areas in Asia, as in Singapore [ 20 ].…”

A Cross-Sectional Analysis of Bystander Cardiopulmonary Resuscitation (CPR): Behavioural Changes in the COVID-19 Era

“…The global health crisis induced by coronavirus disease 2019 (COVID-19) has profoundly impacted the international community, public health systems, and economies [1][2][3]. Besides the impact on those infected, the pandemic has also had many indirect public health consequences, namely disruptions to routine care and health-seeking behaviours [4][5][6]. A decrease in survival for patients experiencing out-of-hospital cardiac arrest (OHCA) was observed [7,8].…”

Septic and febrile kidney stone presentations during the COVID-19 pandemic

“…[1][2][3][4] There are studies in other fields that have demonstrated worse presentation and outcomes of diseases that may have been improved with earlier intervention and assessment. 5,6 Renal colic, which affects approximately 12% of men and 6% of women, is one of the most common presentations to the ED. 7 Some studies have reported a decrease in the number of patients seeking urologic care, urology referrals, and similar or greater risk of admission during the early phase of the pandemic.…”