Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Seiffert, Moritz; Brunner, Fabian J.; Remmel, Marko; Thomalla, Götz; Marschall, Ursula; L’Hoest, Helmut; Acar, Laura; Debus, Eike Sebastian; Blankenberg, Stefan; Gerloff, Christian; Behrendt, Christian‐Alexander

doi:10.1007/s00392-020-01723-9

Cited by 65 publications

(60 citation statements)

References 32 publications

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“…This finding might well be attributed to the fact that symptoms from acute aortic syndromes are so striking, that the potential reluctance to seek medical advice, which has been reported in other types of cardiovascular disease such as ACS, is overridden by the urge to seek medical help [ 5 ]. This is also backed by a German analysis on admissions for acute myocardial infarction, acute limb ischaemia, aortic rupture, stroke or transient ischaemic attack (TIA) between 1 January 2019 and 31 May 2020 that found a decline in admissions between 9% and 15% for all other conditions but no decline in admissions for aortic rupture [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Czerny

Gottardi

Puiu

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89–1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76–0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (−40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Czerny

Gottardi

Puiu

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…These findings of decreases in SAH volumes, including embolisation of ruptured aneurysms, are similar to reports of decreases in stroke admissions, intravenous thrombolysis, MT and acute ST-elevation myocardial infarction (STEMI) activations during the COVID-19 pandemic. 10 13 21 As postulated with reasons for the decline in stroke admissions in the stroke literature, 8 patients with milder presentations of aneurysmal SAH may be afraid to present to a hospital due to fear of contracting SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

“…1 Changes in prehospital emergency medical service, emergency room care, acute stroke and subarachnoid haemorrhage (SAH) protocols 2 3 were reported to conserve resources and to mitigate infection risk to patients and their providers. Decreases in ischaemic stroke admission, rates of intravenous thrombolysis (IVT) [4][5][6] and mechanical thrombectomy (MT) volume 7 were reported in several regions in Europe, 8 9 Germany, 10 China, 11 Brazil 12 and the USA, 13 14 with steeper declines in stroke hospitalisations seen in areas with higher COVID-19 hospitalisation volume. 15 However, there is a paucity of information on the impact of the COVID-19 pandemic on SAH admissions.…”

Section: Introductionmentioning

confidence: 99%

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

et al. 2021

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BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170–1035 procedures, respectively, representing an 11.5% (95%CI −13.5% to −9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI −28.0% to −22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.InterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

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“…Auch aus Deutschland liegt eine Reihe von Publikationen zu diesem Thema vor [ 17 – 21 ]. Eine Analyse aus einer Klinik in Rheinland-Pfalz ergab weniger Aufnahmen wegen NSTEMI im Vergleich zu den Vormonaten und auch zu den entsprechenden Monaten in den Vorjahren bei vergleichbaren Zahlen bei Patienten mit STEMI.…”

Section: Rückgang Der Aufnahmen Von Patienten Mit Akutem Herzinfarktunclassified

COVID-19-Pandemie

Zeymer

Gitt

Thiele

2021

Herz

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Die COVID-19(„coronavirus disease 2019“)-Pandemie hat zu einer Fokussierung der Akutmedizin auf die Versorgung von Patienten mit SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-infizierten Patienten geführt – mit Auswirkungen auf alle anderen medizinischen Gebiete. In den Monaten von März bis Mai 2020 kam es zu einem Rückgang der Krankenhausaufnahmen sowohl für elektive kardiologische Prozeduren als auch für akute kardiologische Erkrankungen. Die Anzahl von Patienten mit akutem Herzinfarkt, insbesondere mit Nicht-ST-Strecken-Hebungs-Infarkt, ist während dieser Monate zurückgegangen, und es zeigte sich auch teilweise eine Zunahme der Zeit zwischen Symptombeginn und Krankenhausaufnahme. In einigen Untersuchungen wurde auch eine Erhöhung der infarktbezogenen Mortalität beobachtet. Die Gründe sind vielfältig und beinhalten eine Furcht der Patienten vor dem Krankenhausaufenthalt mit möglicher Ansteckung mit SARS-CoV‑2, Missdeutung der Symptome und Fokussierung des Gesundheitssystems auf die Pandemie. Zusätzlich kann SARS-CoV‑2 zu einer höheren Thromboseneigung führen und damit schwerere Verläufe eines Myokardinfarkts induzieren.

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Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Cited by 65 publications

References 32 publications

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

COVID-19-Pandemie

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