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. 2023 May 11;2(1):e000207.
doi: 10.1136/bmjmed-2022-000207. eCollection 2023.

Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis

Raul G Nogueira  1 , Katherine Etter  2 , Thanh N Nguyen  3 , Shelly Ikeme  4 , Charlene Wong  2 , Michael Frankel  5   6 , Diogo C Haussen  5   6 , Carlos Del Rio  7 , Michael McDaniel  8 , Rajesh Sachdeva  9 , Chandan M Devireddy  10 , Alhamza R Al-Bayati  1 , Mahmoud H Mohammaden  5 , Mohamed F Doheim  1 , Agostinho C Pinheiro  1 , Bernardo Liberato  5   6 , Dinesh V Jillella  5   6 , Nirav R Bhatt  1 , Rahul Khanna  11
Affiliations

Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis

Raul G Nogueira et al. BMJ Med. .

Abstract

Objective: To measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction.

Design: A retrospective analysis.

Setting: 746 qualifying hospitals in the USA from the Premier Healthcare Database.

Participants: Patients aged 18 years and older who were admitted to hospital with a primary diagnosis of acute ischemic stroke or acute myocardial infarction between 1 March 2019 and 28 February 2021.

Main outcome measures: Relative changes in volumes were assessed for acute ischemic stroke and acute myocardial infarction hospital admissions as well as intravenous thrombolysis, mechanical thrombectomy, and percutaneous coronary intervention (overall and for acute myocardial infarction only) across the first year of the pandemic versus the prior year. Mortality in hospital and length of stay in hospital were also compared across the first year of the pandemic versus the corresponding period the year prior. These metrics were explored across the different pandemic waves.

Results: Among 746 qualifying hospitals, admissions to hospital were significantly reduced after the covid-19 pandemic compared with before the pandemic for acute ischemic stroke (-13.59% (95% confidence interval-13.77% to -13.41%) and acute myocardial infarction (-17.20% (-17.39% to -17.01%)), as well as intravenous thrombolysis (-9.47% (-9.99% to -9.02%)), any percutaneous coronary intervention (-17.89% (-18.06% to -17.71%)), and percutaneous coronary intervention for acute myocardial infarction (-14.36% (-14.59% to -14.12%)). During the first year of the pandemic versus the previous year, the odds of mortality in hospital for acute ischemic stroke were 9.00% higher (3.51% v 3.16%; ratio of the means 1.09 (95% confidence interval (1.03 to 1.15); P=0.0013) and for acute myocardial infarction were 18.00% higher (4.81% v 4.29%; ratio of the means 1.18 (1.13 to 1.23); P<0.0001).

Conclusions: We observed substantial decreases in admissions to hospital with acute ischemic stroke and acute myocardial infarction, but an increase in mortality in hospital throughout the first year of the pandemic. Public health interventions are needed to prevent these reductions in future pandemics.

Keywords: COVID-19; Myocardial infarction; Stroke.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW) trial. Funding for this project is provided by Cerenovus. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, and Viseon. TNN reports research support from Medtronic, Society of Vascular and Interventional Neurology (SVIN) and Data Safety Monitoring Board participation on the TESLA, ENDOLOW, SELECT-2, PROST, CREST-2, and WE-TRUST trials. KE, SI, CW, and RK are employees of Johnson & Johnson and provided analytical support for this manuscript. DCH reports consulting fees from Stryker, Cerenovus and Vesalio and stock options in VizAI. CMD reports consulting fees from Medtronic, ReCor Medical, Vascular Dynamics and Proctor fees from Edwards Lifesciences. ARAB reports consulting fees from Stryker.

Figures

Figure 1
Figure 1
Flow diagram of hospitals contributing inpatient data continuously from March 2019 to February 2021
Figure 2
Figure 2
Proportion of hospital admissions from acute ischemic stroke and acute myocardial infarction, and covid-19 related deaths from March 2019-February 2021. Deaths due to covid-19 are expressed in numbers ×10-1 (pink line)
Figure 3
Figure 3
Volume of intravenous thrombolysis, mechanical thrombectomy, any percutaneous coronary intervention, and percutaneous coronary intervention with acute myocardial infarction shown as number of admissions as well as covid-19 related deaths per month from March 2019-February 2021. Deaths due to covid-19 are expressed in numbers ×10-1 (pink line)
See this image and copyright information in PMC

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