Abstract
While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.
Highlights
Coronavirus disease (COVID-19) is an infectious disease caused by acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
Hospital admissions for myocardial infarction (MI), pulmonary embolism (PE), and AAD that occurred during the first six weeks following onset of COVID-19 associated restrictive social measures (RM) in Styria were quantified, analyzed, and compared to admissions that occurred during respective time frames in the years 2016, 2017, 2018, and 2019, or to admissions that occurred during the six weeks before onset of RM
Given that time from symptoms to first medical contact was longer during the COVID-19 pandemic in other studies [20], we speculate that the increase of intrahospital mortality in our study despite fewer admissions during COVID-19 associated RM may result from a delay in seeking medical assistance
Summary
Coronavirus disease (COVID-19) is an infectious disease caused by acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 may directly impact cardiovascular disease and outcomes, and a bi-directional association between COVID-19 and CVD may exist where one increases and worsens the prognosis of the other [2, 10]. Given the significant incidence of acute coronary events and PE in the general population, a thorough evaluation of the frequency and potential causes of complications and mortality of cardiovascular emergencies is imperative to assess overall virus-dependent and–independent impact on cardiovascular emergencies during the COVID-19 associated pandemic. We performed a real-world analysis comparing admission rates, complications and mortality of selected pre-defined life-threatening cardiovascular emergencies (MI, PE, AAD) during and outside of strict COVID-19 associated RM by interrogating a patient information system covering more than 85% of acute hospital admissions in the state of Styria, Austria, comprising a general population of about 1.24 million people
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