RESUMEN
Background The acuity and magnitude of the first wave of the COVID-19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID-19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID-19 positive) were admitted for an acute cardiovascular syndrome during the first COVID-19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71-6.05] versus 2.87 [1.82-4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID-19-related admissions, all cause in-hospital mortality, or incidence of out-of-hospital cardiac deaths in New York. Admission during the first COVID-19 surge along with age and positive COVID-19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001). Conclusions A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID-19 pandemic, might have accounted for higher in-hospital cardiovascular mortality during that period.
Asunto(s)
COVID-19 , Enfermedades Cardiovasculares/mortalidad , Mortalidad Hospitalaria/tendencias , Hospitalización , Pacientes Internos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
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Asunto(s)
COVID-19 , Muerte Súbita Cardíaca/etnología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Paro Cardíaco Extrahospitalario/etnología , Determinantes Sociales de la Salud , Negro o Afroamericano , Anciano , Escolaridad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Densidad de Población , Pobreza , Factores Raciales , Características de la Residencia , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
The coronavirus disease-2019 (COVID-19) pandemic has overwhelmed healthcare systems around the world, resulting in morbidity, mortality, and a dramatic economic downturn In the United States. Urgent responses to the pandemic halted routine hospital workflow in an effort to increase hospital capacity, maintain staffing, and ration protective gear. Most notably, New York saw the largest surge of COVID-19 cases nationwide. Healthcare personnel and physician leaders at Northwell Health, the largest healthcare system in New York, have worked together to successfully implement operational changes resulting in a paradigm shift in cardiac care delivery. In this manuscript, we detail specific protocol adjustments made in our cardiology department, cardiology service line, and healthcare system in the face of the COVID-19 pandemic. We discuss the sustainability of this shift moving forward and the opportunity to optimize care for cardiovascular patients in the post COVID-19 era.