Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Acute Admissions at the Emergency and Cardiology Departments Across Europe - 19/04/21

Doi : 10.1016/j.amjmed.2020.08.043

Mateusz Sokolski, MD, PhD ^a, Piotr Gajewski, MD ^a, Robert Zymliński, MD, PhD, PD ^a, Jan Biegus, MD, PhD, PD ^a, Jurrien M. Ten Berg, MD, PhD, MSc, FESC, FACC ^b, Wilbert Bor, MD ^b, Frieder Braunschweig, MD, PhD, FESC, FACC ^c, Daniel Caldeira, MD, PhD ^d, Florim Cuculi, MD ^e, Emilia D'Elia, MD, PhD ^f, Istvan Ferenc Edes, MD, PhD ^g, Mateusz Garus, MD ^h, John P. Greenwood, MBChB, PhD, FRCP ⁱ, Frank R. Halfwerk, MD, MSc ^j, Gerhard Hindricks, MD ^k, Juhani Knuuti, MD, PhD ^l, Steen Dalby Kristensen, MD, DMSc, FESC ^m, Ulf Landmesser, MD, PhD ^n,^o, Lars H. Lund, MD, PhD ^c, Alexander Lyon, MA, BMBCh, PhD, FRCP ^p, Alexandre Mebazaa, MD, PhD, FESC ^q, Béla Merkely, MD, PhD, MSc, Dsc, FESC, FACC ^g, Sylwia Nawrocka-Millward, MD ^h, Fausto J. Pinto, MD, PhD, FESC, FACC, FSCAI, FASE ^d, Frank Ruschitzka, MD, FRCP, FESC ^r, Edimir Semedo, MD ^j, Michele Senni, MD, PhD, FESC ^f, Alireza Sepehri Shamloo, MD ^k, Jacob Sorensen, MD, PhD ^m, Carsten Stengaard, MD, PhD ^m, Holger Thiele, MD, FESC ^k, Stefan Toggweiler, MD ^e, Andrzej Tukiendorf, PhD ^s, Patrick M. Verhorst, MD, PhD ^j, David Jay Wright, MD, PhD ^t, Pepe Zamorano, MD, PhD, FESC ^u, Michel Zuber, MD, PhD ^e, Jagat Narula, MD, PhD ^v, Jeroen J. Bax, MD, PhD, FESC, FACC ^w, Piotr Ponikowski, MD, PhD, FESC ^a,^⁎
^a Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
^b Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
^c Unit of Cardiology, Department of Medicine and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
^d Cardiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte(CHULN),Lisbon Academic Medical Centre, Lisbon, Portugal
^e Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
^f Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
^g Heart and Vascular Center, Semmelweis University, Budapest, Hungary
^h Department of Cardiology, University Hospital, Wroclaw, Poland
ⁱ Leeds University and Leeds Teaching Hospitals NHS Trust, UK
^j Thorax Center Twente, Medisch Spectrum Twente, Enschede, The Netherlands
^k Heart Center Leipzig at University of Leipzig, Leipzig, Germany
^l Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
^m Department of Cardiology, Aarhus University Hospital, Denmark
ⁿ German Center for Cardiovascular Research (DZHK), Lübeck, Germany
^o Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
^p Department of Cardiology, Royal Brompton Hospital, London UK
^q Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Université de Paris, Paris, France
^r University Heart Center, University Hospital Zurich, Zurich, Switzerland
^s Department of Public Health, Wrocław Medical University, Poland
^t Liverpool Heart and Chest Hospital, Liverpool, UK
^u Department of Cardiology, University Hospital Ramón y Cajal Carretera de Colmenar, Madrid, Spain
^v Department of Cardiology, Mount Sinai Hospital, New York, NY
^w Department of Cardiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands

^⁎Requests for reprints should be sent to Piotr Ponikowski, MD, PhD, FESC, Head of Centre for Heart Diseases, Jan Mikulicz-Radecki University Hospital in Wroclaw, Borowska 213, 50-556 Wroclaw, Poland.Head of Centre for Heart DiseasesJan Mikulicz-Radecki University Hospital in WroclawBorowska 213Wroclaw50-556Poland

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Abstract

Purpose

We evaluated whether the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic was associated with changes in the pattern of acute cardiovascular admissions across European centers.

Methods

We set-up a multicenter, multinational, pan-European observational registry in 15 centers from 12 countries. All consecutive acute admissions to emergency departments and cardiology departments throughout a 1-month period during the COVID-19 outbreak were compared with an equivalent 1-month period in 2019. The acute admissions to cardiology departments were classified into 5 major categories: acute coronary syndrome, acute heart failure, arrhythmia, pulmonary embolism, and other.

Results

Data from 54,331 patients were collected and analyzed. Nine centers provided data on acute admissions to emergency departments comprising 50,384 patients: 20,226 in 2020 compared with 30,158 in 2019 (incidence rate ratio [IRR] with 95% confidence interval [95%CI]: 0.66 [0.58-0.76]). The risk of death at the emergency departments was higher in 2020 compared to 2019 (odds ratio [OR] with 95% CI: 4.1 [3.0-5.8], P < 0.0001). All 15 centers provided data on acute cardiology departments admissions: 3007 patients in 2020 and 4452 in 2019; IRR (95% CI): 0.68 (0.64-0.71). In 2020, there were fewer admissions with IRR (95% CI): acute coronary syndrome: 0.68 (0.63-0.73); acute heart failure: 0.65 (0.58-0.74); arrhythmia: 0.66 (0.60-0.72); and other: 0.68(0.62-0.76). We found a relatively higher percentage of pulmonary embolism admissions in 2020: odds ratio (95% CI): 1.5 (1.1-2.1), P = 0.02. Among patients with acute coronary syndrome, there were fewer admissions with unstable angina: 0.79 (0.66-0.94); non-ST segment elevation myocardial infarction: 0.56 (0.50-0.64); and ST-segment elevation myocardial infarction: 0.78 (0.68-0.89).

Conclusion

In the European centers during the COVID-19 outbreak, there were fewer acute cardiovascular admissions. Also, fewer patients were admitted to the emergency departments with 4 times higher death risk at the emergency departments.

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Keywords : Acute cardiovascular admissions, Acute coronary syndrome, COVID-19, Outbreak, SARS-CoV2

Plan

Patients Admitted to the Emergency Departments

Patients Admitted to the Cardiology Departments

Discussion

Conclusion

	Funding: None.
	Conflicts of Interest: None.
	Authorship: All authors had access to the data and a role in writing this manuscript.

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Vol 134 - N° 4

P. 482-489 - avril 2021 Retour au numéro

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Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Acute Admissions at the Emergency and Cardiology Departments Across Europe - 19/04/21

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