31 Days of COVID-19 - Cardiac Events During Restriction of Public Life: A Comparative Study

Abstract

Background: The outbreak of novel coronavirus SARS-CoV-2 led to the most recent pandemic of the 21 st century. To contain further spread of the virus, many nations introduced a national lockdown including public measures limiting social interaction. How the pandemic itself and measures of social restriction affect hospital admissions due to acute cardiac events has rarely been evaluated yet. Methods: German public authorities announced a national lockdown including rigorous measures of social restriction between March 21 st and April 20 th, 2020. During this period, all patients suffering from an acute cardiac event admitted to Ulm University Hospital from the greater Ulm area (N=94) were assessed and incidence rate ratios (IRR) of admissions for acute cardiac events estimated, and compared with those during the same period in the previous three years (2017-2019, N=361). Findings: During social restriction, admissions due to cardiac emergencies were reduced by 22% compared to previous years (n=94 vs. n=120/y). Whereas IRR for STEMI 1.20 (95% CI 0.67-2.14) and sudden cardiac death IRR 0.82 (95% CI 0.33-2.02) remained similar, overall admissions with an IRR of 0.78 (95% CI 0.62-0.98) and IRR for NSTEMI with 0.46 (95% CI 0.27-0.78) were significantly lower compared to previous years. In STEMI patients, plasma concentrations of high-sensitivity troponin T at admission were significantly higher in 2020 (644 ng/l, IQR 372-2388) compared to 2017-2019 (195 ng/l, IQR 84-1134; p=0.02). Interpretation: The SARS-CoV-2 pandemic and concomitant social restrictions are associated with a reduction of admissions because of cardiac emergencies admitted at a tertiary care center. From a public health perspective strategies have to be developed to assure patients are seeking and getting medical care and treatment in time in potential in cardiac emergencies during SARS-CoV-2 pandemic. Funding Statement: Local funding by University Hospital of Ulm and University of Ulm, Germany. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study complies with the Declaration of Helsinki and was approved by the local ethics committee (Number of application and positive vote 130/20).