How Does SARS-CoV-2 Infection Affect Survival of Emergency Cardiovascular Patients? A Cohort Study From a German Insurance Claims Database

Abstract

WHAT THIS PAPER ADDSThis large scale analysis of nationwide and unselected health insurance claims data covering 316 718 hospitalisations for cardiovascular and cerebrovascular emergencies between January 2017 and October 2020 in Germany revealed an association between the COVID-19 pandemic and acute stroke and confirmed SARS-CoV-2 infection (for acute stroke, acute limb ischaemia, transient ischaemic attack) led to increased in hospital mortality in patients admitted with cardiovascular and cerebrovascular emergencies. These striking results add to the extremely limited knowledge base concerning a possible relationship between COVID-19 and stroke. Future studies are necessary to determine underlying causal factors.Objective: A previous study revealed a preliminary trend towards higher in hospital mortality in patients admitted as an emergency with acute stroke during the COVID-19 pandemic in Germany. The current study aimed to further examine the possible impact of a confirmed SARS-CoV-2 infection on in hospital mortality. Methods: This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalised for ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), aortic rupture, acute stroke, or transient ischaemic attack (TIA) between 1 January 2017, and 31 October 2020, were included. Admission rates per 10 000 insured and mortality were compared between March À June 2017 e 2019 (pre-COVID) and March À June 2020 (COVID). Mortality rates were determined by the occurrence of a confirmed SARS-CoV-2 infection. Results: A total of 316 718 hospitalisations were included (48.7% female, mean 72.5 years), and 21 191 (6.7%, 95% CI 6.6% e 6.8%) deaths occurred. In hospital mortality increased during the COVID-19 pandemic when compared with the three previous years for patients with acute stroke from 8.3% (95% CI 8.0 e 8.5) to 9.6% (95% CI 9.1 e 10.2), while no statistically significant changes were observed for STEMI, NSTEMI, ALI, aortic rupture, and TIA. When comparing patients with confirmed SARS-CoV-2 infection (2.4%, 95% CI 2.3 e 2.5) vs. non-infected patients, a higher in hospital mortality was observed for acute stroke (12.4% vs. 9.0%), ALI (14.3% vs. 5.0%), and TIA (2.7% vs. 0.3%), while no statistically significant differences were observed for STEMI, NSTEMI, and aortic rupture. Conclusion: This retrospective analysis of claims data has provided hints of an association between the COVID-19 pandemic and increased in hospital mortality in patients with acute stroke. Furthermore, confirmed SARS-CoV-2 infection was associated with increased mortality in patients with stroke, TIA, and ALI. Future studies are urgently needed to better understand the underlying mechanism and relationship between the new coronavirus and acute stroke.

A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

“… 43 Similar findings were also reported by a German study that analysed health insurance claims data, which observed a higher mortality in COVID-19 patients admitted for cardiovascular conditions such as acute stroke, acute limb ischaemia and transient ischaemic attacks. 44 On the contrary, the COVER tier 2 study demonstrated a elevated in-hospital mortality risk across patients who underwent aortic, carotid or lower limb procedures despite a low (4%) COVID-19 infection rate. 40 The authors of the COVER tier 2 study attributed the increase of in-hospital mortality to indirect effects of the COVID-19 pandemic such as delayed presentation, case postponement, increased size threshold for aortic aneurysm repair, and infrastructure change.…”

Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

“…When comparing ALI in patients with COVID-19 (2.4%) with those who were not infected, a higher in hospital mortality was observed (14.3% vs. 5.0%, p < .001). 57…”

Mitteilungen der Deutschen Gesellschaft für Neurologie

“…Hinsichtlich der Versorgung zeigte eine retrospektive Studie der BARMER Krankenkasse [20], dass die Pandemie die Schlaganfall-Versorgung negativ beeinflusst. So gab es während der ersten Pandemie-Welle im Vergleich zum Vorjahr 9 % weniger Schlaganfall-bedingte Hospitalisierungen und 15 % weniger TIAs.…”