Impact of COVID-19 pandemic on cardiovascular diseases hospitalisation, management and mortality in Switzerland

Abstract

Background: COVID-19 pandemic led to a reduction in hospital admissions and intervention for other diseases in many countries. We aimed to assess the effect of COVID-19 pandemic on cardiovascular disease (CVD) hospitalisations, management and mortality in Switzerland.

Methods: Swiss hospital discharge and mortality data for period 2017-2020. CVD hospitalisations, CVD interventions and CVD mortality were assessed before (2017-2019) and during (2020) the pandemic. Expected numbers of admissions, interventions and deaths for 2020 were computed using simple linear regression model.

Results: Compared with 2017-2019, 2020 was characterised by a reduction of CVD admissions in age groups 65-84 and ≥85 by approximately 3700 and 1700 cases, respectively, and by an increase in the percentage of admissions with a Charlson index >8. The total number of CVD-related deaths decreased from 21 042 in 2017 to 19 901 in 2019, and increased to 20 511 in 2020, with an estimated excess of 1139 deaths. This increase was due to out-of-hospital deaths (+1342), while the number of in-hospital deaths decreased from 5030 in 2019 to 4796 in 2020, which concerned mostly subjects aged ≥85 years. The total number of admissions with cardiovascular interventions increased from 55 181 in 2017 to 57 864 in 2019, and decreased in 2020, with an estimated reduction of 4414 admissions; percutaneous transluminal coronary angioplasty (PTCA) was the exception, as the number and percentage of emergency admissions with PTCA increased. The preventive measures applied against COVID-19 inverted the seasonal pattern of CVD admissions, the highest number of admissions being found in summer and the lowest in winter.

Conclusion: The COVID-19 pandemic led to a reduction in CVD hospital admissions, planned CVD interventions, an increase in total and out-of-hospital CVD deaths and a change in seasonal patterns.

Keywords: COVID-19; Death, Sudden, Cardiac; Endovascular Procedures; Epidemiology.

Figure 1

Observed and expected number of CVD admissions (A) and CVD-related mortality (B–D) before (2017–2019) and during (2020) the pandemic; expected values were calculated with simple linear regression model. For better visualisation of the results, the Y axes have been cut. CVD, cardiovascular diseases.

Figure 2

Comparison of quarterly CVD hospitalisations and CVD-related mortality before (2017–2019) and during (2020) the pandemic. (A) Number of CVD hospitalisations before (2017–2019) and during (2020) the pandemic; (B) average number of CVD hospitalisations before the pandemic (2017–2019) and the number of CVD hospitalisations during (2020) the pandemic; (C) number of CVD-related deaths before (2017–2019) and during (2020) the pandemic; (D) average number of quarterly CVD-related deaths before the pandemic (2017–2019) and number of CVD hospitalisations during (2020) the pandemic. CVD, cardiovascular diseases; Q (1–4), quarter (1–4) of the respective years.

Figure 3

Observed and expected number of admissions with all CVD procedures (A), PTCA procedures (B), CABG procedures (C) and other heart operations (apart from PTCA and CABG) (D) before (2017–2019) and during (2020) the pandemic; expected values were calculated with simple linear regression model. For better visualisation of the results, the Y axes have been cut. CVD, cardiovascular diseases; PTCA, percutaneous transluminal coronary angioplasty; CABG, coronary artery bypass graft.

Figure 4

Incidence of confirmed COVID-19 (SARS-CoV-2) infections in Switzerland in 2020 (A), and the number of CVD hospitalisations in Switzerland and the timeline of major restrictive measures in 2020 (B). CVD, cardiovascular diseases.