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. 2020 Dec;109(12):1540-1548.
doi: 10.1007/s00392-020-01723-9. Epub 2020 Aug 4.

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Moritz Seiffert #  1   2 , Fabian J Brunner #  1 , Marko Remmel  1 , Götz Thomalla  3 , Ursula Marschall  4 , Helmut L'Hoest  4 , Laura Acar  4 , Eike S Debus  5 , Stefan Blankenberg  1   2 , Christian Gerloff  3 , Christian-Alexander Behrendt  6
Affiliations

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Moritz Seiffert et al. Clin Res Cardiol. 2020 Dec.

Abstract

Aims: The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany.

Methods and results: This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January-May 2019 (pre-COVID) to January-May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3-6.6), non-ST-segment elevation myocardial infarction (16.8-14.6), acute limb ischemia (5.1-4.6), stroke (35.0-32.5) and TIA (13.7-11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5-9.8%).

Conclusions: Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients' comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients' outcomes.

Keywords: COVID-19; Emergencies; Health services research; Myocardial infarction; Pandemic; Stroke.

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Conflict of interest statement

Dr. Seiffert reports non-financial support from Abbott Vascular, personal fees from Abiomed, personal fees from AstraZeneca, personal fees from Bayer Healthcare, non-financial support from Biotronik, personal fees from Boehringer Ingelheim, personal fees and non-financial support from Boston Scientific, personal fees from Bristol-Myers Squibb, non-financial support from Edwards Lifesciences, non-financial support from Nicolai Medizintechnik, non-financial support from OrbusNeich Medical, grants and personal fees from Philips, and personal fees from Medtronic outside the submitted work. Dr. Brunner reports grant from the ASPIRE Cardiovascular grant award, Pfizer, outside the submitted work. Dr. Thomalla has received reports grant support and lecture fees from Bayer, personal fees from Acandis, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, Portola, and Stryker outside the submitted work. Dr. Gerloff reports personal fees from Amgen, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. Dr. Behrendt and Dr. Debus report grants from the German Federal Joint Committee and grants from German Stifterverband outside the submitted work. The other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Monthly admission rates for cardiovascular and cerebrovascular emergencies per 100,000 insured in Germany for ST-segment elevation myocardial infarction (dark red) and non-ST-segment elevation myocardial infarction (light red) (a) for acute limb ischemia (b), aortic rupture (c), and acute stroke (dark green) and transient ischemic attack (light green) (d) between January 2019 and May 2020. The gray line with shade denotes the annual mean for 2019 with a corresponding limit of agreement
Fig. 2
Fig. 2
Percentage of patients admitted for cardiovascular and cerebrovascular emergencies, who underwent respective interventional or open-surgical treatment. Rates per month are given for ST-segment elevation myocardial infarction (dark red) and non-ST-segment elevation myocardial infarction (light red) (a) for acute limb ischemia (b), aortic rupture (c), and acute stroke (dark green) and transient ischemic attack (light green) (d) between January 2019 and May 2020. The gray line denotes the annual mean for 2019
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