Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

Abstract

Aims: During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region.

Methods and results: Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99-1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01-1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05-1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures.

Conclusion: During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality.

Keywords: Acute coronary syndrome; COVID-19; Cardiovascular mortality; Chronic coronary syndrome; SARS-CoV2 pandemic.

Fig. 1

All-cause mortality, cardiovascular mortality, and other causes of death during the lockdown period in 2020 in comparison to the non-pandemic period in 2019

Fig. 2

Map of the state of Hesse, including all participating hospitals to the CoVCAD-Study: (1) Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Giessen (2) Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Dept. of Cardiology, Rotenburg (3) Hessenklinik Stadtkrankenhaus Korbach, Korbach (4) Sana Klinikum Offenbach, Dept. of Cardiology, Offenbach (5) Lahn-Dill-Kliniken, Klinikum Wetzlar, Dept. of Cardiology, Wetzlar (6) St. Josefs-Hospital Wiesbaden, Dept. of Cardiology, Wiesbaden (7) Agaplesion Frankfurter Diakonie Kliniken, Dept. of Cardiology, Frankfurt (8) Helios Dr. Horst Schmidt Kliniken, Dept. of Cardiology, Wiesbaden (9) Klinikum Frankfurt Höchst, Dept. of Cardiology, Frankfurt am Main (10) Hochtaunus-Kliniken, Bad Homburg, Dept. of Cardiology (11) Kliniken des Main-Taunus-Kreises, Dept. of Cardiology (12) GPR Gesundheits- und Pflegezentrum Rüsselsheim, Dept. of Cardiology, Rüsselsheim (13) Diakonie-Krankenhaus Wehrda, Dept. of Cardiology, Marburg (14) Asklepios Kliniken Langen, Dept. of Cardiology, Langen (15) Department of Internal Medicine/Cardiology and Angiology, University Hospital of Marburg, Marburg (16) Kerckhoff Heart Center, Dept. Of Cardiology, Bad Nauheim (17) Eichhof-Stiftung Lauterbach, Dept. of Cardiology (18) Klinikum Fulda, Dept. of Cardiology, Fulda (19) Agaplesion Evangelisches Krankenhaus Mittelhessen, Dept. of Cardiology Giessen (20) Asklepios Schwalm-Eder-Kliniken, Dept. of Cardiology, Schwalmstadt (21) Klinikum Werra Meissner GmbH, Dept. of Cardiology, Eschwege (22) Krankenhaus Sachsenhausen, Dept. of Cardiology, Frankfurt am Main (23) Kreisklinik Groß-Umstadt, Dept. of Cardiology, Groß-Umstadt (24) Klinikum Hanau, Dept. of Cardiology, Hanau (25) Klinikum Darmstadt, Dept. of Cardiology, Darmstadt (26) University of Frankfurt, Dept. of Cardiology, Frankfurt