Collateral effect of the COVID-19 pandemic on cardiology service provision and cardiovascular mortality in a population-based study: COVID-COR-LT.

BACKGROUND: Collateral damage of the COVID-19 pandemic on cardiovascular health is increasingly studied. This is a population-based study addressing multiple aspects of cardiovascular care during the pandemic in a country of Lithuania, in which pandemic waves were significantly different. METHODS: Data on cardiology outpatient care, hospitalizations and cardiovascular mortality in 2019 and 2020 were collected from Lithuanian nationwide administrative databases and registries. Weekly data and aggregated numbers of corresponding 6-week phases were analyzed comparing the numbers between 2019 and 2020. Age, sex and regional subgroup analysis was performed. RESULTS: Both cardiovascular outpatient care visits and hospitalizations decreased dramatically in 2020 compared to 2019 with a peak reduction (up to - 60% for both) during the first pandemic wave in spring of 2020. Simultaneously, cardiovascular mortality was much higher in 2020, with a pronounced peak at the end of the year compared to 2019 (up to 46%). The increase was even more staggering when analyzing home deaths, which rose up to 91% by the end of 2020. Notable differences between age groups, regions and sexes were documented. CONCLUSION: A profound indirect damage of COVID-19 pandemic on cardiovascular care was observed in this study, with striking decreases in cardiovascular care provision and concurrent increase in cardiovascular mortality, both overall and, even more dramatically, at home. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05021575 (registration date 25-08-2021, retrospectively registered).

Increase of Myocardial Ischemia Time and Short-Term Prognosis of Patients with Acute Myocardial Infarction during the First COVID-19 Pandemic Wave.

Background and objectives: early reports showed a decrease in admission rates and an increase in mortality of patients with acute myocardial infarction (AMI) during the first wave of COVID-19 pandemic. We sought to investigate whether the COVID-19 pandemic and associated lockdown had an impact on the ischemia time and prognosis of patients suffering from AMI in the settings of low COVID-19 burden. Materials and Methods: we conducted a retrospective data analysis from a tertiary center in Lithuania of 818 patients with AMI. Data were collected from 1 March to 30 June in 2020 during the peri-lockdown period (2020 group; n = 278) and compared to the same period last year (2019 group; n = 326). The primary study endpoint was all-cause mortality during 3 months of follow-up. Secondary endpoints were heart failure severity (Killip class) on admission and ischemia time in patients with acute ST segment elevation myocardial infarction (STEMI). Results: there was a reduction of 14.7% in admission rate for acute myocardial infarction (AMI) during the peri-lockdown period. The 3-month mortality rate did not differ significantly (6.9% in 2020 vs. 10.5% in 2019, p = 0.341 for STEMI patients; 5.3% in 2020 vs. 2.6% in 2019, p = 0.374 for patients with acute myocardial infarction without ST segment elevation (NSTEMI)). More STEMI patients presented with Killip IV class in 2019 (13.5% vs. 5.5%, p = 0.043, respectively). There was an increase of door-to-PCI time (54.0 [42.0-86.0] in 2019; 63.5 [48.3-97.5] in 2020, p = 0.018) and first medical contact (FMC)-to-PCI time (101.0 [82.5-120.8] in 2019; 115 [97.0-154.5] in 2020, p = 0.01) during the pandemic period. Conclusions: There was a 14.7% reduction of admissions for AMI during the first wave of COVID-19. FMC-to-PCI time increased during the peri-lockdown period, however, it did not translate into worse survival during follow-up.