ABSTRACT
The COVID-19 pandemic placed a significant burden on the German healthcare system. Based on the experience of severe disease progression of the SARS-CoV2 infection from neighboring European countries in the early 2020s, with ICU overload and high mortality rates, efforts were made in Germany to increase the capacity of available ICU beds. Subsequently, all documentation and reporting focused on the ICU capacities for COVID-19 patients. It was hypothesized that mainly a few large hospitals provided care for the majority of COVID-19 patients. The COVID-19 Registry RLP of Rhineland-Palatinate documented SARS-CoV2 inpatients from daily mandatory queries of all hospitals throughout the pandemic from April 2020 to March 2023, distinguishing between patients in ICUs and normal wards. In its 18th Corona Ordinance, the state government required all hospitals to participate in the care of SARS-CoV2 inpatients. We investigated the participation of hospitals at different levels of care in Rhineland-Palatinate in the management of the COVID-19 pandemic. Nine pandemic waves were documented during the pandemic and exemplary data on the respective pandemic peaks were evaluated. A distinction was made between the burden on hospitals at different levels of care: primary care hospitals, standard care hospitals, specialty hospitals, and maximal care hospitals. Analysis of the data showed that all hospital types participated equally in the care of SARS-CoV-2 patients. The requirement of the Ministry of Health of Rhineland-Palatinate to provide at least 20% of the available capacity was met by all levels of care and there were no disparities between hospitals of different levels of care in the management of the pandemic.Hospitals at all levels of care participated equally in the care of SARS-CoV2 inpatients and thus contributed significantly to the management of the pandemic in Rhineland-Palatinate.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , SARS-CoV-2 , Pandemics , Hospitals , RegistriesABSTRACT
The outbreak of the COVID-19 pandemic in March 2020 influenced treatment strategies and behaviors, particularly cardiovascular emergencies, which may have led to cardiovascular collateral damage. This review article covers aspects of the changing spectrum of cardiac emergencies with a focus on acute coronary syndrome rates and cardiovascular mortality and morbidity based on a selected literature review including the most recent comprehensive meta-analyses.
Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Emergencies , Pandemics , LungABSTRACT
BACKGROUND: Reports about the influence of the COVID-19 pandemic on the number of hospital admissions and in-hospital mortality during the first wave between March and May 2020 showed conflicting results and are limited by single-center or limited regional multicenter datasets. Aim of this analysis covering all German federal states was the comprehensive description of hospital admissions and in-hospital mortality during the first wave of the COVID-19 pandemic. METHODS AND RESULTS: We conducted an observational study on hospital routine data (§21 KHEntgG) and included patients with the main diagnosis of acute myocardial infarction (ICD 21 and ICD 22). A total of 159 hospitals included 36,329 patients in the database, with 12,497 patients admitted with ST-elevation myocardial infarction (STEMI) and 23,832 admitted with non-ST-elevation myocardial infarction (NSTEMI). There was a significant reduction in the number of patients admitted with STEMI (3748 in 2020, 4263 in 2019 and 4486 in 2018; p < 0.01) and NSTEMI (6957 in 2020, 8437 in 2019 and 8438 in 2020; p < 0.01). These reductions were different between the Federal states of Germany. Percutaneous coronary intervention was performed more often in 2020 than in 2019 (odds ratio 1.13, 95% confidence interval [CI] 1.06-1.21) and 2018 (odds ratio 1.20, 95% CI 1.12-1.29) in NSTEMI and more often than in 2018 (odds ratio 1.26, 95% CI 1.10-1.43) in STEMI. The in-hospital mortality did not differ between the years for STEMI and NSTEMI, respectively. CONCLUSIONS: In this large representative sample size of hospitals in Germany, we observed significantly fewer admissions for NSTEMI and STEMI during the first COVID-19 wave, while quality of in-hospital care and in-hospital mortality were not affected. Admissions for STEMI and NSTEMI during the months March to May over 3 years and corresponding in-hospital mortality for patients with STEMI and NSTEMI in 159 German hospitals. (p-value for admissions 2020 versus 2019 and 2018: < 0.01; p-value for mortality: n.s.).
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has led to a focus of acute medical care on the treatment of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and pneumonia with consequences for all other medical specialties. Between March and May 2020 a decline in the number of admissions for elective cardiac procedures as well as for cardiac emergencies was observed. The number of patients hospitalized for acute myocardial infarction decreased, especially those with non-ST elevation myocardial infarction (NSTEMI), while time intervals between symptom onset and admission sometimes increased. In some studies an increase in infarct-related mortality was reported. There are multiple possible reasons for these findings, which include fear of patients to become infected with SARS-CoV2 in hospital, misinterpretation of symptoms and focusing of the healthcare system on the pandemic. In addition, SARS-CoV2 can lead to a higher proneness to thrombosis and therefore induce more severe courses of myocardial infarction.