Characteristics and hospital course of patients admitted for acute cardiovascular diseases during the coronavirus disease-19 outbreak

Abstract

Introduction During the coronavirus disease-19 (COVID-19) outbreak in spring 2020, people may have been reluctant to seek medical care fearing infection. We aimed to assess the number, characteristics and in-hospital course of patients admitted for acute cardiovascular diseases during the COVID-19 outbreak. Methods We enrolled all consecutive patients admitted urgently for acute myocardial infarction, heart failure or arrhythmias from 1 March to 31 May 2020 (outbreak period) and 2019 (control period). We evaluated the time from symptoms onset to presentation, clinical conditions at admission, length of hospitalization, in-hospital medical procedures and outcome. The combined primary end point included in-hospital death for cardiovascular causes, urgent heart transplant or discharge with a ventricular assist device. Results A similar number of admissions were observed in 2020 (N = 210) compared with 2019 (N = 207). Baseline characteristics of patients were also similar. In 2020, a significantly higher number of patients presented more than 6 h after symptoms onset (57 versus 38%, P < 0.001) and with signs of heart failure (33 versus 20%, P = 0.018), required urgent surgery (13 versus 5%, P = 0.004) and ventilatory support (26 versus 13%, P < 0.001). Hospitalization duration was longer in 2020 (median 10 versus 8 days, P = 0.03). The primary end point was met by 19 (9.0%) patients in 2020 versus 10 (4.8%) in 2019 (P = 0.09). Conclusion Despite the similar number and types of unplanned admissions for acute cardiac conditions during the 2020 COVID-19 outbreak compared with the same period in 2019, we observed a higher number of patients presenting late after symptoms onset as well as longer and more complicated clinical courses.

Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis

“…Of these, the majority were from Europe with one from Australia 17 and two from Asia. 18 , 19 One reported overall CV disease, which included heart failure (HF), acute myocardial infarction, and arrhythmias, 20 eight described acute coronary syndromes (ACS), and six described HF. Most studies used the same period in a preceding year for comparison, to account for seasonal variability.…”

“…The majority of studies reported a decline in admission rate during the COVID-19 pandemic, ranging from a 1% 23 to 81% 19 reduction, with only four reporting an increase in admission rate. 18 , 20 , 22 , 24 The mean age of patients was 68 years in both COVID-19 and comparator cohorts and the percentage of male patients was 68% and 67%, respectively. The median length of the COVID-19 observation period was 55 [IQR 30–54] days compared with 60 [IQR 30–120] days in the comparator period.…”

Impact of COVID-19 on the lives and psychosocial well-being of persons with epilepsy during the third trimester of the pandemic: Results from an international, online survey

“…Almost half of PWE presented reluctance to seek medical care and 61.4% felt unsafe about going to the hospital. Delayed arrival at the emergency department due to reluctance to seek medical care has been reported in several studies [23][24][25][26]. Therefore, it should be emphasized to PWE that measures are in place to assure safety in the hospital and that non-COVID-19-related healthcare should not be postponed.…”

The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

“…a dual track system) are able to face the adverse effects of the pandemic in terms of in-hospital mortality containment for AMI and stroke patients, ensuring appropriate levels of clinical care for admitted patients with non-Covid and non-deferrable clinical conditions. Moreover, as suggested by recent studies [38], better communication strategies should be implemented in epidemic times by public health authorities to ensure timely presentation of individuals (preventing the huge increase in time to door registered during Covid-19 outbreak) with acute non-deferrable diseases such as AMI and stroke. This is particularly important in a regional context where the strong impact caused by Covid epidemic has moved experts and health managers on re-thinking the system supporting the best practices which have been able to timely and safely help in reacting to the unexpected health emergency ( [39,40]).…”

“…Considering the relevant increase in time from the onset of symptoms to hospital presentation, indeed data on other outcomes also need to be considered (e.g. in-hospital heart failure, need for inotropic infusion, ejection fraction at discharge) in future studies to investigate more in depth if any relevant adverse effect (in addition to mortality rate) has been experienced by AMI and stroke patients during Covid-19 time [37,38].…”