Emergency department admissions for myocardial infarction and stroke in France during the first wave of the COVID-19 pandemic: National temporal trends and regional disparities

Olié, Valérie; Carcaillon‐Bentata, Laure; Thiam, Marie-Michèle; Haeghebaert, S.; Caserio-Schönemann, Céline

doi:10.1016/j.acvd.2021.01.006

Cited by 14 publications

(16 citation statements)

References 13 publications

(30 reference statements)

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“…13 Like other authors, we observed the opposite, namely a decrease in hospitalization rate for AIS during the initial wave, and normal AIS hospitalization rates at later stages of the pandemic. [1][2][3][4][5][6][7][8][9] Certain selective processes during the pandemic are also implied by the fact that comorbidities among AIS patients were consistently less frequent throughout the pandemic and by a decrease in the CMI during all four pandemic waves.…”

Section: Discussionmentioning

confidence: 99%

“…During the early stages of the global COVID-19 pandemic, the prevalence of hospitalization for acute ischemic stroke (AIS) decreased and, in some countries, AIS case fatality rose. [1][2][3][4][5][6][7][8][9] These findings are unusual given that the overwhelming majority of cases were SARS-CoV-2-negative patients and hospitals in most parts of the world were accessible for emergency stroke care without significant interruption of service. 1,[10][11][12] The most commonly suggested explanation is that fear of hospital-acquired COVID-19 caused AIS patients to delay or defer hospital presentation.…”

Section: Introductionmentioning

confidence: 94%

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Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Dengler

Prass

Palm³

et al. 2022

European Stroke Journal

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Introduction: In the early stages of the global COVID-19 pandemic hospital admissions for acute ischemic stroke (AIS) decreased substantially. As health systems have become more experienced in dealing with the pandemic, and as the proportion of the population vaccinated rises, it is of interest to determine whether the prevalence of AIS hospitalization and outcomes from hospitalization have returned to normal. Patients and methods: In this observational, retrospective cohort study, we compared the prevalence and outcomes of AIS during the first four waves of the pandemic to corresponding pre-pandemic periods in 2019 using administrative data collected from a nationwide network of 76 hospitals that manages 7% of all in-hospital cases in Germany. Results: We included 25,821 AIS cases in the study period (2020/2021) and used 26,295 AIS cases as controls (2019). Compared to pre-pandemic numbers, mean daily AIS admissions decreased only during wave 1 (from 39.6 to 34.1; p < 0.01) and wave 2 (from 39.9 to 38.3; p = 0.03) and returned to normal levels during waves 3 and 4. AIS case fatality increased in wave 1 only (from 6.0% to 7.6%; p = 0.03). We observed a consistent decrease in the prevalences of arterial hypertension, diabetes, and obesity among AIS cases throughout the pandemic and no changes in rates of systemic thrombolysis, mechanical thrombectomy, or decompressive craniectomy. The rate of transfer to stroke units increased only during waves 2 (by 4.6%; p < 0.01) and 3 (by 3.0%; p < 0.01). The proportion of patients with coinciding SARS-CoV-2 and AIS was low, peaking at 3.4% in wave 2 and subsequently decreasing to 0.4% in wave 4. Conclusion: In Germany, the COVID-19 pandemic seems to have had a larger effect on nationwide in-hospital AIS care during the early pandemic stages, in which AIS case numbers decreased and case fatality rose. This may reflect a nationwide “learning curve” within health care systems in providing AIS care in times of a pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Dengler

Prass

Palm³

et al. 2022

European Stroke Journal

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“…The increased time to contact the healthcare system during the COVID-19 pandemic is consistent with prior reports from France and elsewhere. 6 13 30 Mesnier et al , in a French cohort of 1167 patients who had an STEMI, found that symptom onset to hospital admission times were stable from 4 weeks before to 4 weeks after lockdown implementation. However, comparison of that work and ours is hampered by differences in management times and study periods.…”

Section: Discussionmentioning

confidence: 99%

“…This study was restricted to Aquitaine, one of the regions least affected by the first wave of the pandemic. 6 We hypothesised that the ‘decrease in non-COVID patients management and admission capacities’, which did not affect STEMI and stroke patient management times, would have degraded the management of non-COVID-19 conditions in regions with many EUs. Indeed, the impact of EU reorganisations may be sensitive to patient influx.…”

Section: Discussionmentioning

confidence: 99%

“…Use of care was altered 5 ; all countries that implemented policies to prevent the spread of SARS-CoV-2 experienced a marked decrease in the number of patients entering emergency rooms for reasons other than COVID-19, revealing a tendency to delay or even forego care. [6][7][8][9] Concerns rose about the quality of management of acute conditions other than COVID-19, particularly stroke and ST-segment elevation myocardial infarction (STEMI), the most highly time-sensitive conditions. 10 11 Management pathways for these two diseases have long been established, based initially on the patient's use of the emergency medical service (EMS) system in the event of an extreme emergency, followed by relays between emergency structures and specialised technical platforms (cathlabs, stroke units).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France

et al. 2022

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ObjectiveTo assess the impact of changes in use of care and implementation of hospital reorganisations spurred by the COVID-19 pandemic (first wave) on the acute management times of patients who had a stroke and ST-segment elevation myocardial infarction (STEMI).DesignTwo cohorts of patients who had an STEMI and stroke in the Aquitaine Cardio-Neuro-Vascular (CNV) registry.Setting6 emergency medical services, 30 emergency units (EUs), 14 hospitalisation units and 11 cathlabs in the Aquitaine region.ParticipantsThis study involved 9218 patients (6436 patients who had a stroke and 2782 patients who had an STEMI) in the CNV Registry from January 2019 to August 2020.MethodHospital reorganisations, retrieved in a scoping review, were collected from heads of hospital departments. Other data were from the CNV Registry. Associations between reorganisations, use of care and care management times were analysed using multivariate linear regression mixed models. Interaction terms between use-of-care variables and period (pre-wave, per-wave and post-wave) were introduced.Main outcome measuresSTEMI cohort, first medical contact-to-procedure time; stroke cohort, EU admission-to-imaging time.ResultsPer-wave period management times deteriorated for stroke but were maintained for STEMI. Per-wave changes in use of care did not affect STEMI management. No association was found between reorganisations and stroke management times. In the STEMI cohort, the implementation of systematic testing at admission was associated with a 41% increase in care management time (exp=1.409, 95% CI 1.075 to 1.848, p=0.013). Implementation of plan blanc, which concentrated resources in emergency activities, was associated with a 19% decrease in management time (exp=0.801, 95% CI 0.639 to 1.023, p=0.077).ConclusionsThe pandemic did not markedly alter the functioning of the emergency network. Although stroke patient management deteriorated, the resilience of the STEMI pathway was linked to its stronger structuring. Transversal reorganisations, aiming at concentrating resources on emergency care, contributed to maintenance of the quality of care.Trial registration numberNCT04979208.

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Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis

et al. 2022

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Background In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Methods Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). Results A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year. Conclusions ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies. Graphical abstract

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Emergency department admissions for myocardial infarction and stroke in France during the first wave of the COVID-19 pandemic: National temporal trends and regional disparities

Cited by 14 publications

References 13 publications

Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France

Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis

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