Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Abstract

Background: The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. Concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2.

Methods: We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1-9, 2020) and after (calendar weeks 10-16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year.

Results: In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p = 0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p = 0.0012). Admissions due to ACS decreased by 41% (p = 0.0023 for all; Δ - 71% (p = 0.007) for unstable angina, Δ - 25% (p = 0.42) for myocardial infarction with ST-elevation and Δ - 17% (p = 0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1-9 to 62 patients in calendar weeks 10-16. ACVE decreased numerically by 20% [p = 0.25 for all; transient ischemic attack: Δ - 32% (p = 0.18), ischemic stroke: Δ - 23% (p = 0.48), intracerebral haemorrhage: Δ + 57% (p = 0.4)]. There was no significant change in ACVE per week (p = 0.7) comparing calendar weeks 1-9 (213 patients) and weeks 10-16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020.

Conclusions: The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

Keywords: Acute coronary syndrome; COVID-19; Cardiovascular events; Cerebrovascular events; SARS-CoV-2.

Fig. 1

Emergency department visit volume. Comparison of the number of patients during calendar weeks 1–16 in 2019 and 2020

Fig. 2

Box plot of patients at calendar weeks 1–9 and 10–16 in the year 2020. a Emergency department visit volume. b Acute coronary syndrome. c Combination of ischemic stroke, transient ischemic attack (TIA) and intracerebral haemorrhage (ICH)

Fig. 3

Acute coronary syndrome. a Accumulated number of patients with acute coronary syndrome in the emergency department at calendar weeks 1–16 in the year 2019 and 2020. Number of patients at calendar weeks 1–16 in the year 2019 and 2020 with myocardial infarction with (b, STEMI) and without (c, NSTEMI) ST-elevation and unstable angina (d)

Fig. 4

Acute cerebrovascular events. a Accumulated number of patients with ischemic stroke, transient ischemic attack (TIA) and intracerebral haemorrhage (ICH) at calendar weeks 1–16 in the year 2019 and 2020. Number of patients at calendar weeks 1–16 in the year 2019 and 2020 with ischemic stroke (b), TIA (c) and ICH (d)

Fig. 5

Virological test volume for SARS-CoV-2 for patients at the Saarland University Medical Center