Changes in the Diagnosis of Stroke and Cardiovascular Conditions in Primary Care During the First 2 COVID-19 Waves in the Netherlands

Abstract

Background and objectivesAlthough there is evidence of disruption in acute cerebrovascular and cardiovascular care during the COVID-19 pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in GP-recorded diagnoses of selected cerebrovascular and cardiovascular outcomes.MethodsFrom electronic health records of 166,929 primary care patients aged 30 or over within the Rotterdam region, the Netherlands, we extracted the number of consultations related to cerebrovascular and cardiovascular care, and first diagnoses of selected cerebrovascular and cardiovascular risk factors (hypertension, diabetes, lipid disorders), conditions and events (angina, atrial fibrillation, TIA, myocardial infarction, stroke). We quantified changes in those outcomes during the first COVID-19 wave (March-May 2020) and thereafter (June-December 2020) by comparing them to the same period in 2016-2019. We also estimated the number of potentially missed diagnoses for each outcome.ResultsThe number of GP consultations related to cerebrovascular and cardiovascular care declined by 38% (0.62, 95% CI: 0.56-0.68) during the first wave, as compared to expected counts based on pre-pandemic levels. Substantial declines in the number of new diagnoses were observed for cerebrovascular events: 37% for TIA (0.63, 0.41-0.96), and 29% for stroke (0.71, 0.59 to 0.84), while no significant changes were observed for cardiovascular events (myocardial infarction (0.91, 0.74-1.14), angina (0.77, 0.48-1.25)). The counts across individual diagnoses recovered following June 2020, but the number of GP consultations related to cerebrovascular and cardiovascular care remained lower than expected also throughout the June-December period (0.93, 0.88-0.98).DiscussionWhile new diagnoses of acute cardiovascular events remained stable during the COVID19 pandemic, diagnoses of cerebrovascular events declined substantially compared to pre-pandemic levels, possibly due to incorrect perception of risk by patients. These findings emphasize the need to improve symptom recognition of cerebrovascular events among the general public and to encourage urgent presentation despite any physical distancing measures.

The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany

“…However, while a patient-centered survey by Schuster et al (22) revealed that the share of patient-initiated cancellations of primary care appointments was smaller than healthcare-initiated, only 37% of outpatient physicians surveyed in this study agreed that the decline could be traced back to the provider behavior, whereas 97% saw the cause in the changed patient behavior. Furthermore, recent studies support the thesis that the patient's behavior could be reasonable for the delay of outpatient service utilization regarding preventive care and visits for chronic diseases due to anxiety, reduced social activities, increased infection risk and a lack of perception of non-disabling symptoms (20,(23)(24)(25)(26). The surveyed physicians supported these indications, confirming (97%) reasons for declined disease recognition remain in changed patient behavior.…”

“…Several studies have evaluated the impact of the early COVID-19 pandemic on primary care consultations, representing a dramatic decline ( 9 , 11 , 13 , 14 , 20 ). This analysis confirmed this decrease in outpatient consultations, especially at the beginning of the pandemic during the nationwide contact bans.…”

The impact of the SARS-CoV-2 pandemic on cause-specific mortality patterns: a systematic literature review

“…Moreover, many cardiovascular diseases are time-dependent. An overwhelmed and fully committed health care system in the fight against respiratory disease caused by the SARS-CoV-2 pandemic partially neglected time-dependent conditions (Fox et al 2022 ; Velek et al 2022 ).…”

The Collateral Damage of COVID-19

“…It has been demonstrated that the widespread postponement of elective procedures and visits, coupled with anxiety about COVID-19 exposure, caused larger disruptions in care for people with chronic illnesses. 4 Velek et al 3 report age and sex differences, with people over 65 and women experiencing the largest declines in GP encounters, but they did not evaluate how social determinants of health (SDOH) may differentially affect GP consultations and new diagnoses. This could be due to relative homogeneity of the study population or unavailability of SDOH metrics.…”

“…In this issue of Neurology ®, Velek and colleagues 3 published a study that starts to fill this gap by highlighting the inadvertent effects of the COVID-19 pandemic on the population-wide burden of cerebrovascular disease. Using electronic health records from 18% of the general practices (GPs) in the Rotterdam region in the Netherlands, the authors found that new diagnoses of stroke and TIA had declined by 29% and 37%, respectively, during the first pandemic wave (March–May 2020) compared to prepandemic derived expected counts.…”