In‐hospital care in acute heart failure during the <scp>COVID</scp>‐19 pandemic: insights from the <scp>German‐wide Helios</scp> hospital network

König, Sebastian; Hohenstein, Sven; Meier‐Hellmann, Andreas; Kuhlen, Ralf; Hindricks, Gerhard; Bollmann, Andreas

doi:10.1002/ejhf.2044

Cited by 58 publications

(82 citation statements)

References 45 publications

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“…The observed changes of in-hospital mortality during the pandemic are of interest but a detailed analysis of this observation is beyond the scope of the present study. Nevertheless, a previous study from our group that focussed on heart failure care has shown an association between increased case severity during the pandemic and in-hospital mortality [14].…”

Section: Limitationsmentioning

confidence: 84%

Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

et al. 2021

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Background During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01–1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00–1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78–1.31], P<0.95). Conclusions There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.

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Section: Limitationsmentioning

confidence: 84%

Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

et al. 2021

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“…During the course of the COVID‐19 pandemic, reduced hospitalization rates were described for multiple acute cardiovascular and non‐cardiovascular diseases 1‐14 . Since most of the previous investigations focused on the early phase of the pandemic in spring 2020, data concerning the development of hospitalization rates following April 2020 are scarce 15‐18 . Evidence of an increased case‐severity respective mortality, especially in patients with cardiovascular diseases, led to concern that those reduced treatment numbers could negatively affect patients' long‐term outcome 9,15,19 .…”

Section: Introductionmentioning

confidence: 99%

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

König

Ueberham

Pellissier

et al. 2021

Clinical Cardiology

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Background Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID‐19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long‐term course of hospital admission numbers, (b) provide data for in‐ and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures. Methods and Results Administrative data of patients with ICD‐10‐encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in‐ or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS‐codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of −10% to −16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in‐ and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: −10%; cardiac electronic device implantations: −7%; percutaneous cardiovascular interventions: −9%; cardiovascular surgery: −15%). Conclusions This study provides data on the long‐term development of cardiovascular patient care during the COVID‐19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.

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“…The Helios hospital group is the largest hospital network in Germany serving about 7% of the German population. We have established a continuous surveillance program to monitor and report the effects of the Covid-19 pandemic on hospital admissions, resource use and outcomes [ [6] , [7] , [8] , [9] , [10] ]. With this correspondence, we wish to complement this discussion by providing hospitalization, treatment and in-hospital outcome data for pulmonary embolism during the 2020 Covid-19 pandemic and a corresponding 2016–2019 control period.…”

mentioning

confidence: 99%

Hospitalizations, resource use and outcomes of acute pulmonary embolism in Germany during the Covid-19 pandemic

Husser

Hohenstein

Pellissier

et al. 2021

Thrombosis Research

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In‐hospital care in acute heart failure during the COVID‐19 pandemic: insights from the German‐wide Helios hospital network

Cited by 58 publications

References 45 publications

Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

Hospitalizations, resource use and outcomes of acute pulmonary embolism in Germany during the Covid-19 pandemic

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