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. 2021 Jul 7:14:17562864211029540.
doi: 10.1177/17562864211029540. eCollection 2021.

Persistent decline of hospitalizations for acute stroke and acute coronary syndrome during the second wave of the COVID-19 pandemic in Greece: collateral damage unaffected

Christos Katsouras  1 , Georgios Tsivgoulis  2 , Michail Papafaklis  1 , Theodore Karapanayiotides  3 , Dimitrios Alexopoulos  4 , Evangelos Ntais  5 , Georgia Papagiannopoulou  2 , Ioanna Koutroulou  3 , Antonios Ziakas  6 , Georgios Sianos  6 , Antonios Kouparanis  6 , Paraskevi Trivilou  4 , Christos Ballas  1 , Ioanna Samara  1 , Maria Kosmidou  5 , Lina Palaiodimou  2 , Nikolaos Grigoriadis  3 , Lampros K Michalis  1 , Sotirios Giannopoulos  2
Affiliations

Persistent decline of hospitalizations for acute stroke and acute coronary syndrome during the second wave of the COVID-19 pandemic in Greece: collateral damage unaffected

Christos Katsouras et al. Ther Adv Neurol Disord. .

Abstract

Background: An alarming cerebro/cardiovascular collateral damage, reflected by a decline in admissions for acute stroke (AS) and acute coronary syndrome (ACS), was observed during the initial phase of the COVID-19 pandemic, thereby leading to a re-design of public campaigns. However, there are limited data regarding the AS and ACS hospitalization rates during the second wave of the pandemic, which was followed by re-imposition of lockdowns.

Methods: We calculated the rate of AS and ACS hospitalizations from three representative tertiary care hospitals in Greece during a 2-month period (November-December 2020) of the second wave of the COVID-19 pandemic compared with the corresponding control period in 2019 from three representative tertiary care hospitals in Greece. This was a follow-up study with identical design to our previous report evaluating AS and ACS hospitalizations during the first wave of the pandemic (March-April 2020).

Results: Compared with 2019, there was a 34% relative reduction of AS hospitalizations [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.48-0.92, p = 0.013] and 33% relative reduction of ACS hospitalizations (IRR: 0.67, 95% CI: 0.54-0.83, p < 0.001) during the second wave of the COVID-19 pandemic. The relative reduction was smaller and did not reach the level of statistical significance for the respective syndromes (haemorrhagic stroke: IRR 0.87, 95% CI: 0.41-1.82, p = 0.71; ST-elevation myocardial infarction: IRR 0.81, 95% CI: 0.57-1.14, p = 0.22).

Conclusion: AS and ACS hospitalizations were persistently reduced during the second wave of the COVID-19 pandemic compared with 2019 in Greece. This decline was similar to the observations during the first wave despite the large differences in the epidemiological COVID-19 burden. Lockdowns, a common characteristic in both waves, appear to have a detrimental indirect impact on cerebro/cardiovascular diseases in the general population.

Keywords: COVID-19; Greece; acute coronary syndromes; admissions; intracerebral haemorrhage; ischaemic stroke; stroke.

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Conflict of interest statement

Conflict of interest statement: Georgios Tsivgoulis is Associate Editor at Therapeutic Advances in Neurological Disorders, therefore, the peer review process was managed by alternative members of the Board and the submitting Editor was not involved in the decision-making process.

Figures

Figure 1.
Figure 1.
Number of acute stroke hospitalizations in three tertiary hospitals in Greece during the last 2 months of 2020 compared with the corresponding period in 2019. Relative (per cent) changes are presented for each stroke subtype. CVA, cerebrovascular accident; IRR, incidence rate ratio.
Figure 2.
Figure 2.
Number of acute coronary syndrome (ACS) hospitalizations in three tertiary hospitals in Greece during the last 2 months of 2020 compared with the corresponding period in 2019. Relative (per cent) changes are presented for ACS subtype. IRR, incidence rate ratio; NSTEMI, non-STEMI; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.
Figure 3.
Figure 3.
The incidence rate ratio (IRR) of admissions (i.e. relative change in COVID-19 compared with the control period). Blue and orange lines indicate IRR and 95% confidence intervals. ACS, acute coronary syndrome; AS, acute stroke; NSTEMI, non-STEMI; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.
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