The Impact of the COVID-19 Pandemic on the Treatment and Prognosis of AMI in Urban and Rural Areas in Developing Country (preprint)

Background: COVID-19 continues to spread globally, this study is the first to explore the impact of COVID-19 on the treatment and prognosis of rural and urban acute myocardial infarction (AMI) in developing country. Methods: A total of 128 patients with AMI in our hospital during the COVID-19 pandemic (January 25, 2020-March 24, 2020) were enrolled. As a control group, a total of 197 patients diagnosed with AMI from November 25, 2019 to January 24, 2020 were selected. A total of 1 year of follow-up was performed. In addition to basic clinical data, this study focused on the treatment time, Killip class and hospital stay, the event of interest was defined as MACE (all-cause death, reinfarction, new congestive heart failure). Results: Compared with Before COVID-19 group, the proportion of killip class≥2 was significantly higher in During COVID-19 group in AMI Total. In Rural AMI, hospital stay and the proportion of killip class≥2 were increased in During COVID-19 group. In STEMI Total and Rural STEMI, the treatment time in During COVID-19 group was longer than that in Before COVID-19 group, while only S to D Total and D to B were extended in Urban STEMI. The proportion of Invasive treatment time within 24 hours in NSTEMI patients was obviously lowered in During COVID-19 group. In AMI Total and Rural AMI, MACE and all-cause mortality were increased in During COVID-19 group compared with Before COVID-19 group. Through Kaplan-Meier analysis, it was found that the survival and the occurrences of MACE in AMI Total and Rural AMI were significantly higher in During COVID-19 group. Conclusion: COVID-19 pandemic can lead to delayed treatment and worse prognosis in AMI patients, and rural areas seem to be more worrying.

Short-Term Lifestyle Alteration and All-Cause Mortality: Lessons from COVID-19 Prevention in a Low-Transmission Region (preprint)

Background: The COVID-19 mortality is very low in the regions with a low transmission rate and sufficient medical resources. However, strict prevention measures greatly altered people’s social activities, diet, and hygienic habits, which had potential impact on non-COVID-19 deaths. Therefore, this study is to evaluate the impact of short-term lifestyle change on non-COVID deaths in the region with a low COVID-19 transmission rate.Methods: We performed a retropective observational study with statiscal analysis via Student’s t-test (significance defined as P-value < 0.05). The number of registered deaths among 8.8 million permanent residents with specific causes from January 2018 to June 2020 were sourced from Xuzhou Center for Disease Control and Prevention. Death rates were calculated and compared by weeks, months, and years with a focus on the period of COVID-19 pandemic from Jan 24 to March 27, 2020 in Xuzhou, Jiangsu Province, China.Findings: Within the COVID-19 timeframe, all-cause mortality (138.03/105 vs. 158.28/105 vs. 152.57/105, P < 0.001), respiratory disorders (13.99/105 vs. 24.48/105 vs. 21.22/105, P < 0.001), cerebrovascular diseases (36.35/105 vs. 38.69/105 vs. 38.61/105, P < 0.05), and cardiovascular diseases (35.70/105 vs. 42.06/105 vs. 39.55/105, P < 0.001) are consistently lower than those in the same period in 2018 and 2019. The traffic death dropped significantly, while mortalities of mental health disorders and out-of-hospital sudden death significantly increased during the pandemic time.Interpretation: Our study suggests the short-term lifestyle alteration can have significant impact on all-cause mortality. This could provide evidences for adjusting future healthcare policies to reduce specific-cause mortalities such as respiratory, cardiovascular and cerebrovascular diseases.Trial Registration: This study was registered at the ClinicalTrials.gov (NCT 04550312). Funding: Xuzhou Talent Fellowship Program 2019.Conflict of Interest: We declare no competing interests.Ethical Approval: The medical research ethics committee of the affiliated hospital of Xuzhou Medical University, Xuzhou, approved the study (9th, September 2020, No. XYFY2020-KL142-01).

Impact of Lifestyle Alteration on Non-COVID Deaths by Prevention Measures in the Region with a Low COVID-19 Transmission Rate (preprint)

Background: The increase of all-cause mortality in the areas with high COVID-19 transmission rate due to COVID-19 deaths and the collateral damage to other healthcare problems is well-known. However, the COVID-19 mortality is low in the regions with a low transmission rate and sufficient medical resources. In such regions, strict prevention measures altered people’s lifestyle and hygienic habits and had an impact on non-COVID-19 deaths. Yet, this aspect needs to be elucidated further.Methods: The number of registered deaths among 8.8 million permanent residents with specific causes from January 2018 to June 2020 were estimated. Death rates were calculated and compared by weeks, months, seasons and years with a focus on the period of the COVID-19 pandemic from January 24 to March 27, 2020. The numerical values of all-cause death and the death rates of non-COVID diseases were compared in various time points.Findings: During the pandemic in Xuzhou region, a total of 79 COVID-19 infected patients were diagnosed and treated. Meanwhile, stringent public health measures were taken to contain the virus transmission. Surprisingly, mortalities of all-cause casualty, respiratory disorders, cerebrovascular disease, and cardiovascular disease are consistently lower than those in the same periods in 2018 and 2019. Moreover, the first two weeks in the lunar new year presented the highest death rates from 2018–2020 and lowest in 2020 due to COVID-19 control. The traffic death dropped significantly, while mortality of mental health disorders and out-of-hospital sudden death significantly increased during the pandemic time.Interpretation: Control strategies in the region of low SARS-CoV-2 transmission rate during the COVID-19 outbreak alter the lifestyles of people and further exert an impact on non-COVID deaths, which could have a practical value in guiding clinical work and future management of chronic diseases.Funding Statement: Xuzhou Talent Fellowship Program 2019Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the Institutional Review Board at the affiliated hospital of Xuzhou Medical University.