The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions

Pines, Jesse M.; Zocchi, Mark S.; Black, Bernard S.; Celedon, Pablo; Carlson, Jestin N.; Moghtaderi, Ali; Venkat, Arvind

doi:10.1016/j.ajem.2021.03.004

Cited by 55 publications

(57 citation statements)

References 23 publications

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“…The present study did not find any difference in the total number of stroke admissions between the two study periods although a decline in the April 2020 correlated with the increasing surge of COVID-19 cases and the acute lockdown period starting from late March 2020. Earlier reports have suggested a significant decline in stroke and coronary artery admissions, possibly related to the reduced number of patients reporting to the hospitals due to fear of COVID-19 or overwhelmed health systems not prioritizing such admissions [ [11] , [12] , [13] , [14] , [15] ]. It is possible that since most of the centres were not admitting COVID positive patients, the usual number of stroke admissions remained constant.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

Bhatia

Sylaja

Srivastava

et al. 2021

Journal of the Neurological Sciences

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Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.

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Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

Bhatia

Sylaja

Srivastava

et al. 2021

Journal of the Neurological Sciences

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“…Our study team has published several studies using this database (<1%). 5,6,10,12,13 Facilities included small-(<30,000 visits per year, n¼40), medium-(30,000 to 59,999 visits per year, n¼56) and large-hospital based EDs (!60,000 visits per year, n¼16) and freestanding EDs (n¼24). Freestanding ED volumes were comparable to those of small-hospital based EDs, but we examined freestanding EDs separately given their different organizational structure.…”

Section: Study Design and Settingsmentioning

confidence: 99%

“…3,4 ED visits declined for both low-acuity and high-acuity conditions, including acute myocardial infarction, stroke, heart failure, and substance use disorders. 5,6 Since that time, ED visit rates have partially recovered, but they remain substantially below 2019 levels. Potential contributors to fewer ED visits include less communicable disease and injury due to public health measures, including social distancing, mask wearing, and school/business closures.…”

Section: Introduction Backgroundmentioning

confidence: 99%

The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care

Pines

Zocchi

Black

et al. 2021

Annals of Emergency Medicine

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Study objective: We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED). Methods:We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes.Results: Following the COVID-19 pandemic's onset, geriatric (age !65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions. Conclusion:The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements. [

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“…Studies from the emergency medicine literature have reported significantly lower overall patient visits and admissions during the pandemic [ [20] , [21] , [22] , [23] , [24] , [25] , [26] ] as well as lower volumes of patients with cardiac emergencies. [ [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. But these studies have not examined delays in processes of care of STEMI patients within the ED.…”

Section: Introductionmentioning

confidence: 99%

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

McLaren¹,

Taher²,

Chartier³

2021

The American Journal of Emergency Medicine

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Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.

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The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions

Cited by 55 publications

References 23 publications

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

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