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Multicenter Study
. 2020 Jun 1;41(32):3045-3054.
doi: 10.1093/eurheartj/ehaa508.

COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests

Enrico Baldi  1   2 , Giuseppe Maria Sechi  3 , Claudio Mare  3 , Fabrizio Canevari  4 , Antonella Brancaglione  4 , Roberto Primi  5 , Catherine Klersy  6 , Alessandra Palo  7 , Enrico Contri  7 , Vincenza Ronchi  7   8 , Giorgio Beretta  9 , Francesca Reali  9 , Pierpaolo Parogni  10 , Fabio Facchin  1 , Ugo Rizzi  11 , Daniele Bussi  11 , Simone Ruggeri  10 , Luigi Oltrona Visconti  5 , Simone Savastano  5 ; Lombardia CARe researchers
Collaborators, Affiliations
Multicenter Study

COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests

Enrico Baldi et al. Eur Heart J. .

Abstract

Aims: An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve.

Methods and results: We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (ρ 0.87, P < 0.001) and for each province separately (Lodi: ρ 0.98, P < 0.001; Cremona: ρ 0.98, P < 0.001; Pavia: ρ 0.87, P < 0.001; Mantova: ρ 0.81, P < 0.001).

Conclusion: The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks.

Keywords: COVID-19; Italy; Out-of-hospital cardiac arrest; SARS-CoV-2.

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Figures

Graphical Abstract
Graphical Abstract
Take home figure
Take home figure
(A) Over a period of 60 days from 20 February, the cumulative incidence of COVID-19 per 100 000 inhabitants in the four provinces and in the overall territory (dotted line) (upper part), and the trend of the difference of OHCA between 2020 and 2019 per 100 000 inhabitants in the four provinces and in the overall territory (dotted line) (bottom part). (B) The cumulative incidence of the difference in OHCA between 2020 and 2019 per 100 000 inhabitants as a function of the cumulative incidence of COVID-19 per 100 000 inhabitants, since 20 February 2020. Dots are the observed values. The red line is the function fitted using fractional polynomials. The shaded area is the 95% CI for the estimates.
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