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. 2022 Dec 9;19(24):16579.
doi: 10.3390/ijerph192416579.

Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown

Dominik Felbel  1 , Sascha d'Almeida  1 , Manuel Rattka  1 , Stefanie Andreß  1 , Kathrin Reischmann  1 , Benjamin Mayer  2 , Armin Imhof  1 , Dominik Buckert  1 , Wolfgang Rottbauer  1 , Sinisa Markovic  1 , Tilman Stephan  1
Affiliations

Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown

Dominik Felbel et al. Int J Environ Res Public Health. .

Abstract

Background: Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse.

Methods: Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January-19 March), lockdown (20 March-19 April), and post-lockdown (20 April-30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR).

Results: Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14-0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31-1.65; p < 0.001) compared to 2019.

Conclusions: We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.

Keywords: COVID-19; admission; cardiac event; deferral; emergency; lockdown; lockdown strategies; non-emergency.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of the number of cardiac emergency and non-emergency admissions in 2019, 2020 and 2022 from 1 January and 30 June.
Figure 2
Figure 2
Incidence rate ratios of cardiac procedures during the lockdown period compared to the reference period in 2019. The x-axis displays the IRR of each intervention type during the lockdown period (20 March–19 April) in 2020 compared to the corresponding period in 2019. IRR: incidence rate ratio; CI: confidence interval; PCI: percutaneous coronary intervention.
Figure 3
Figure 3
Mean admission numbers per day during each period in 2019, 2020 and 2022 stratified by emergency and non-emergency. Pre-Lockdown (1 January to 19 March), Lockdown (20 March–19 April) and Post-Lockdown (20 April to 30 June).
See this image and copyright information in PMC

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