Abstract
In the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.Supplementary InformationThe online version of this article (10.1007/s12471-021-01650-y) contains supplementary material, which is available to authorized users.
Highlights
The first case of coronavirus disease 2019 (COVID-19) in the Netherlands was documented on 27 February 2020
The indication for a cardiac implantable electronic device (CIED) was in accordance with the European Society of Cardiology (ESC) guidelines with the most prevalent indications for an implantable cardioverter-defibrillator (ICD) being primary and secondary prevention in the context of ischaemic heart disease and non-ischaemic cardiomyopathy and the most prevalent for a pacemaker being high-degree atrioventricular (AV) block and symptomatic bradycardia [11, 12]
Since CIED patients are at a higher risk for a complicated course of the infection than the general population, we evaluated the hypothesis that mortality among CIED patients was at least twice as high (56%) as expected during this period
Summary
The first case of coronavirus disease 2019 (COVID-19) in the Netherlands was documented on 27 February 2020. The National Institute for Public Health and the Environment (RIVM) rapidly developed guidelines to minimise the spread and to ‘flatten the curve’. Recommendations included social distancing, general hygiene measures and home isolation [1]. Due to increasing numbers of coronavirus contaminations, an ‘intelligent lockdown’ was instituted, during which schools and restaurants were closed and the public was strongly advised to work from home. The healthcare system was overloaded with COVID-19 patients. Non-urgent care was scaled down and outpatient medical visits were postponed, cancelled or converted to remote consultations
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