Out-of-hospital cardiac arrest incidence in the different phases of COVID-19 outbreak

Baldi, Enrico; Primi, Roberto; Gentile, Francesca Romana; Mare, Claudio; Centineo, Paola; Palo, Alessandra; Reali, Francesca; Rizzi, Ugo; Parogni, Pierpaolo; Visconti, Luigi Oltrona; Savastano, Simone

doi:10.1016/j.resuscitation.2020.12.020

Cited by 12 publications

(10 citation statements)

References 5 publications

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“…Along with the secular trend of reduced hospital access seen in the first months of 2020 and a potential lower incidence of heart attacks (e.g., related to better air quality or reduced mobility), delays in diagnosis or self-limitation of the demand by patients for fear of contagion may have played an important role. Indeed, the lack of timely access to hospital care would be supported by the reported increase in the number of out-of-hospital cardiac arrest deaths 5 , 6 . Moreover, we observed an increase in-hospital mortality among STEMI patients in Lombardy, where the high prevalence of Covid-19 was associated with worse STEMI outcomes 7 .…”

Section: Discussionmentioning

confidence: 99%

Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

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Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January–July 2020 were compared with the corresponding average for 2018–2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30–40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.

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Section: Discussionmentioning

confidence: 99%

Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

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show abstract

“…However, the increase in OHCA incidence has not been observed in all the countries [14], probably as a result of different pandemic burden. Moreover, albeit a correlation between OHCA incidence and COVID-19 case has been suggested both during the ascendant and the descendent phase of the first pandemic wave in the most affected countries [15], it is unknown whether this relationship could be present also during the second pandemic wave. The aim of our study was to analyse the trends of OHCA incidence and COVID-19 along the whole 2020 and to test the presence of a correlation between them during both the first and second pandemic wave at a provincial level.…”

Section: Introductionmentioning

confidence: 99%

Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence

et al. 2021

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Background The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. Aim To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. Methods We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. Results A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Conclusions Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs’ increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.

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“…The secular trend of reduced hospitalization for STEMI may have also played a role, though marginal. Indeed, the lack of timely access to hospital care would also be supported by the reported increase in the number of out-of-hospital cardiac arrest deaths [5,6]. Moreover, we observed an increase in STEMI in-hospital mortality in Lombardy, where the high prevalence of Covid-19 was associated with worse STEMI outcomes [7].…”

Section: Discussionmentioning

confidence: 60%

Monitoring the indirect impact of Covid-19 on hospital care pathways in Italy: results from the Mimico-19 network

Spadea

Girolamo

Landriscina

et al. 2021

Preprint

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The COVID-19 pandemic has a non-negligible indirect impact on hospital care pathways, which is important to estimate. To this aim, we set up the Mimico-19 network of seven Italian regions (62% of the Italian population) representing different socio-demographic areas of the country with also a different burden of the epidemic. We retrospectively analysed regional hospital discharges data, computing twelve indicators of volumes and performance in three clinical areas: cardiology, oncology and orthopaedics, including time-dependent pathways and elective surgery. Weekly indicators for the period January-July 2020 were compared with the average of the corresponding indicators in 2018 and 2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown and post-lockdown. The weekly trend of hospitalizations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Volumes of malignant neoplasms surgeries differed substantially by site, with a limited reduction for lung cancer (<20%) and greater declines (30-40%) for breast and prostate cancers. Hospitalizations for femoral neck fracture in the elderly decreased by 20%, but the percentage of timely interventions remained constantly higher than the previous years. General trends did not show important differences across regions, regardless of the different Covid-19 burden. Hospitalizations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. The drop in the care demand for cardiovascular diseases and cancers needs to be further investigated and monitored more thoroughly.

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Out-of-hospital cardiac arrest incidence in the different phases of COVID-19 outbreak

Cited by 12 publications

References 5 publications

Indirect impact of Covid-19 on hospital care pathways in Italy

Indirect impact of Covid-19 on hospital care pathways in Italy

Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence

Monitoring the indirect impact of Covid-19 on hospital care pathways in Italy: results from the Mimico-19 network

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