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. 2020 Oct;36(10):1680-1684.
doi: 10.1016/j.cjca.2020.07.006. Epub 2020 Jul 17.

Reduced Rate of Hospital Presentations for Heart Failure During the COVID-19 Pandemic in Toronto, Canada

Claudia Frankfurter  1 , Tayler A Buchan  2 , Jeremy Kobulnik  3 , Douglas S Lee  2 , Adriana Luk  2 , Michael McDonald  2 , Heather J Ross  2 , Ana C Alba  4
Affiliations

Reduced Rate of Hospital Presentations for Heart Failure During the COVID-19 Pandemic in Toronto, Canada

Claudia Frankfurter et al. Can J Cardiol. 2020 Oct.

Abstract
in English, French

Coronavirus disease 2019 (COVID-19) has resulted in public health measures and health care reconfigurations likely to have impact on chronic disease care. We aimed to assess the volume and characteristics of patients presenting to hospitals with acute decompensated heart failure (ADHF) during the 2020 COVID-19 pandemic compared with a time-matched 2019 cohort. Patients presenting to hospitals with ADHF from March 1, to April 19, 2020 and 2019 in an urban hospital were examined. Multivariable logistic-regression models were used to evaluate the difference in probability of ADHF-related hospitalization between the 2 years. During the COVID-19 pandemic, a total of 1106 emergency department (ED) visits for dyspnea or peripheral edema were recorded, compared with 800 ED visits in 2019. A decrease in ADHF-related ED visits of 43.5% (14.8%-79.4%, P = 0.002) and ADHF-related admissions of 39.3% (8.6%-78.5%, P = 0.009) was observed compared with 2019. Patients with ADHF presenting to hospitals (n = 128) were similar in age, sex, and comorbidities compared with the 2019 cohort (n = 186); however, a higher proportion had recent diagnoses of heart failure. Upon ED presentation, the relative probability of hospitalization or admission to intensive care was not statistically different. There was a trend toward higher in-hospital mortality in 2020. The decline in ADHF-related hospitalizations raises the timely question of how patients with heart failure are managing beyond the acute-care setting and reinforces the need for public education on the availability and safety of emergency services throughout the COVID-19 pandemic.

La maladie à coronavirus 2019 (COVID-19) a transformé les stratégies de santé publique et les soins de santé, ce qui risque d’avoir des répercussions sur les soins aux patients atteints d’une maladie chronique. Nous avons comparé le nombre de patients qui se sont présentés à l’hôpital en insuffisance cardiaque aiguë décompensée (ICAD) durant la pandémie de COVID-19 et leurs caractéristiques avec le nombre et les caractéristiques des patients traités durant la même période en 2019. Les dossiers des patients qui se sont présentés en ICAD à un hôpital urbain entre le 1er mars et le 19 avril en 2020 et en 2019 ont donc été examinés. La différence entre les probabilités d’hospitalisation pour ICAD en 2020 et en 2019 a été évaluée au moyen de modèles de régression logistique multivariés. Durant la pandémie de COVID-19, on a dénombré en tout 1 106 consultations au service des urgences en raison d’une dyspnée ou d’un œdème périphérique, comparativement à 800 consultations en 2019. Le nombre de consultations au service des urgences en raison d’une ICAD a quant à lui diminué de 43,5 % (14,8 % à 79,4 %, p = 0,002) et le nombre d’admissions à l’hôpital pour ICAD, de 39,3 % (8,6 % à 78,5 %, p = 0,009) de 2019 à 2020. Les patients atteints d’ICAD qui se sont présentés à l’hôpital (n = 128) en 2020 avaient les mêmes caractéristiques que ceux de la cohorte de 2019 (n = 186) pour ce qui est de l’âge, du sexe et des affections concomitantes; toutefois, la proportion de patients ayant récemment reçu un diagnostic d’insuffisance cardiaque était plus élevée. Au moment de la consultation au service des urgences, les probabilités relatives d’hospitalisation ou d’admission aux soins intensifs ne différaient pas de manière significative sur le plan statistique. On observe toutefois une tendance à la hausse du taux de mortalité hospitalière en 2020. Le recul du nombre d’hospitalisations pour ICAD soulève une question pertinente quant au sort des patients atteints d’insuffisance cardiaque en dehors du contexte des soins actifs et renforce la nécessité d’informer le public que les services d’urgence demeurent accessibles et sûrs pendant la pandémie de COVID-19.

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Figures

Figure 1
Figure 1
Patients presenting to the emergency department with dyspnea or peripheral edema (A), with acute decompensated heart failure (ADHF) (B), and with AHDF-related hospitalization (C). The differences in the volume of patients presenting to the emergency department and hospitalized with ADHF between March 1, and April 19 in 2019, and 2020 were more pronounced after the announcement of a provincial lockdown.
Figure 2
Figure 2
Volume of patients presenting to hospital with dyspnea or peripheral edema and specifically with acute decompensated heart failure (ADHF) between March 1 and April 19 in 2019 and 2020. There was an average increase in total emergency deaprtment (ED) visits of 38.3% (26.3%-51.6%, P < 0.001), average decrease in ADHF-related ED visits of 43.5% (14.8%-79.4%, P = 0.002), and average decrease in ADHF-related hospitalizations of 39.3% (8.6%-78.5%, P = 0.009) between 2020 and 2019. These changes were more significant following the declaration of a public lockdown in Ontario, with an observed increase in total ED visits of 44.0% (29.4%-60.3%, P < 0.001), a decrease in ADHF-related ED visits of 79.2% (34.3%-139.0%, P < 0.001), and a decrease in ADHF-related hospitalizations of 64.5% (20.0%-225%, P = 0.002).
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References

    1. Cucinotta D., Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91:157–160. - PMC - PubMed
    1. Madjid M., Safavi-Naeini P., Solomon S.D., Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020 Jul 1;5:831–840. - PubMed
    1. Bhatt A.S., Moscone A., McElrath E.E. Fewer hospitalizations for acute cardiovascular conditions during the COVID-19 pandemic. J AM Coll Cardiol. 2020;76:280–288. - PMC - PubMed
    1. Hall M.E., Vaduganathan M., Khan M.S. Reductions in heart failure hospitalizations during the COVID-19 pandemic. J Card Fail. 2020;26:462–463. - PMC - PubMed
    1. Barghash M.H., Pinney S.P. Heart failure in the COVID-19 pandemic: Where has all New York’s congestion gone? J Card Fail. 2020;26:477–478. - PMC - PubMed

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