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"Missing" acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence?
Papafaklis, Michail I; Katsouras, Christos S; Tsigkas, Grigorios; Toutouzas, Konstantinos; Davlouros, Periklis; Hahalis, George N; Kousta, Maria S; Styliadis, Ioannis G; Triantafyllou, Konstantinos; Pappas, Loukas; Tsiourantani, Fotini; Varytimiadi, Efthymia; Anyfantakis, Zacharias-Alexandros; Iakovis, Nikolaos; Grammata, Paraskevi; Karvounis, Haralambos; Ziakas, Antonios; Sianos, George; Tziakas, Dimitrios; Pappa, Evgenia; Dagre, Anna; Patsilinakos, Sotirios; Trikas, Athanasios; Lamprou, Thomais; Mamarelis, Ioannis; Katsimagklis, Georgios; Karmpaliotis, Dimitri; Naka, Katerina; Michalis, Lampros K.
  • Papafaklis MI; 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
  • Katsouras CS; 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
  • Tsigkas G; Department of Cardiology, Patras University Hospital, Patras, Greece.
  • Toutouzas K; 1st Department of Cardiology, "Hippokration" University Hospital, Athens, Greece.
  • Davlouros P; Department of Cardiology, Patras University Hospital, Patras, Greece.
  • Hahalis GN; Department of Cardiology, Patras University Hospital, Patras, Greece.
  • Kousta MS; Cardiology Department, General Hospital "G. Gennimatas", Athens, Greece.
  • Styliadis IG; 2nd Department of Cardiology, "Papageorgiou" General Hospital, Thessaloniki, Greece.
  • Triantafyllou K; 1st Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece.
  • Pappas L; 2nd Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece.
  • Tsiourantani F; 2nd Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
  • Varytimiadi E; Department of Cardiology, "Attikon" University Hospital, Athens, Greece.
  • Anyfantakis ZA; Department of Cardiology, University Hospital of Larissa, Larissa, Greece.
  • Iakovis N; Department of Cardiology, University Hospital of Larissa, Larissa, Greece.
  • Grammata P; Department of Cardiology, "Sismanogleio" General Hospital, Athens, Greece.
  • Karvounis H; Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece.
  • Ziakas A; Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece.
  • Sianos G; Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece.
  • Tziakas D; Department of Cardiology, University Hospital of Alexandroupolis, Thrace, Greece.
  • Pappa E; Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece.
  • Dagre A; Department of Cardiology, "Thriasion" General Hospital of Elefsina, Attiki, Greece.
  • Patsilinakos S; Department of Cardiology, "Konstandopoulio" General Hospital, Athens, Greece.
  • Trikas A; Department of Cardiology, "Elpis" General Hospital, Athens, Greece.
  • Lamprou T; 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", Piraeus, Greece.
  • Mamarelis I; Department of Cardiology, 401 Army General Hospital, Athens, Greece.
  • Katsimagklis G; Department of Cardiology, Athens Naval Hospital, Athens, Greece.
  • Karmpaliotis D; Department of Cardiology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
  • Naka K; 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
  • Michalis LK; 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
Clin Cardiol ; 43(10): 1142-1149, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-840712
ABSTRACT

BACKGROUND:

Reports from countries severely hit by the COVID-19 pandemic suggest a decline in acute coronary syndrome (ACS)-related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID-19 incidence are not known.

HYPOTHESIS:

ACS admissions were reduced in a country spared by COVID-19.

METHODS:

We conducted a nationwide study on the incidence rates of ACS-related admissions during a 6-week period of the COVID-19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID-19 incidence, and no excess in mortality.

RESULTS:

ACS admissions in the COVID-19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR] 0.72, P < .001) and for each ACS type (ST-segment elevation myocardial infarction [STEMI] IRR 0.76, P = .001; non-STEMI IRR 0.74, P < .001; and unstable angina [UA] IRR 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID-19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non-STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID-19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P < .001).

CONCLUSIONS:

We observed a reduction in ACS hospitalizations during the COVID-19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self-isolation/quarantining may have also played a role.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Coronary Syndrome / COVID-19 / Hospitalization Type of study: Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Cardiol Year: 2020 Document Type: Article Affiliation country: Clc.23424

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Coronary Syndrome / COVID-19 / Hospitalization Type of study: Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Cardiol Year: 2020 Document Type: Article Affiliation country: Clc.23424