Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction?

Abstract

Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.

Keywords: COVID-19 pandemic; acute coronary syndrome; collateral damage; stroke.

Fig. 1. Schematic representation of the rates of CV hospitalizations (blue dashed curve) over three periods: before (green dashed line), during (red dashed line), and after (purple dashed line) the COVID-19 pandemic. Overall, the hospitalization rate was reduced during the COVID-19 pandemic due to ‘A’ medical care avoidance behaviors of the patients (relatively large effect) and ‘B’ a true reduction of the incidence of CV events (relatively small effect). As a result, we observed an immediate impact on excess mortality. After the COVID-19 pandemic, there may be latent consequences (rebound effects) of a substantial increase in the hospitalization rate due to CV diseases from new CV events and chronic CV disease syndromes. CV, cerebro-/cardiovascular; OHCAs, out-of-hospital cardiac arrests.