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Khan Y, Verhaeghe N, Devleesschauwer B, Cavillot L, Gadeyne S, Pauwels N, Van den Borre L, De Smedt D. The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:647-661. [PMID: 37667483 DOI: 10.1093/ehjqcco/qcad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
AIMS Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. METHODS AND RESULTS PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. CONCLUSION The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.
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Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Research Institute for Work and Society, KU Leuven, Leuven 3000, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent 9000, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke 9000, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Research Institute of Health and Society, University of Louvain, Brussels 1200, Belgium
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nele Pauwels
- Faculty of Medicine, Ghent University, Ghent 9000, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
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Zuo M, Xiang S, Bhattacharyya S, Chen Q, Zeng J, Li C, Deng Y, Siu C, Yin L. Management strategies and outcomes of acute coronary syndrome (ACS) during Covid-19 pandemic. BMC Cardiovasc Disord 2022; 22:242. [PMID: 35614403 PMCID: PMC9130978 DOI: 10.1186/s12872-022-02680-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/13/2022] [Indexed: 02/08/2023] Open
Abstract
Background The COVID-19 outbreak represents a significant challenge to international health. Several studies have reported a substantial decrease in the number of patients attending emergency departments with acute coronary syndromes (ACS) and there has been a concomitant rise in early mortality or complications during the COVID-19 pandemic. A modified management system that emphasizes nearby treatment, safety, and protection, alongside a closer and more effective multiple discipline collaborative team was developed by our Chest Pain Center at an early stage of the pandemic. It was therefore necessary to evaluate whether the newly adopted management strategies improved the clinical outcomes of ACS patients in the early stages of the COVID-19 pandemic. Methods Patients admitted to our Chest Pain Center from January 25th to April 30th, 2020 based on electronic data in the hospitals ACS registry, were included in the COVID-19 group. Patients admitted during the same period (25 January to 30 April) in 2019 were included in the pre-COVID-19 group. The characteristics and clinical outcomes of the ACS patients in the COVID-19 period group were compared with those of the ACS patients in the pre-COVID-19 group. Multivariate logistic regression analyses were used to identify the risk factors associated with clinical outcomes.
Results The number of patients presenting to the Chest Pain Center was reduced by 45% (p = 0.01) in the COVID-19 group, a total of 223 ACS patients were included in the analysis. There was a longer average delay from the onset of symptom to first medical contact (FMC) (1176.9 min vs. 625.2 min, p = 0.001) in the COVID-19 period group compared to the pre-COVID-19 group. Moreover, immediate percutaneous coronary intervention (PCI) (80.1% vs. 92.3%, p = 0.008) was performed less frequently on ACS patients in the COVID-19 group compared to the pre-COVID-19 group. However, more ACS patients received thrombolytic therapy (5.8% vs. 0.6%, p = 0.0052) in the COVID-19 group than observed in the pre-COVID-19 group. Interestingly, clinical outcome did not worsen in the COVID-19 group when cardiogenic shock, sustained ventricular tachycardia, ventricular fibrillation or use of mechanical circulatory support (MCS) were compared against the pre-COVID-19 group (13.5% vs. 11.6%, p = 0.55). Only age was independently associated with composite clinical outcomes (HR = 1.3; 95% CI 1.12–1.50, p = 0.003). Conclusion This retrospective study showed that the adverse outcomes were not different during the COVID-19 pandemic compared to historical control data, suggesting that newly adopted management strategies might provide optimal care for ACS patients. Larger sample sizes and longer follow-up periods on this issue are needed in the future.
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Affiliation(s)
- Mingliang Zuo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Shoubo Xiang
- West China Hospital, Sichuan University, Chengdu, China
| | - Sanjib Bhattacharyya
- College of Pharmaceutical Sciences, Southwest University, Beibei, Chongqing, China
| | - Qiuyi Chen
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Li
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Chungwah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1929, Block K, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Lixue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Toušek P, Bauer D, Neuberg M, Nováčková M, Mašek P, Tu Ma P, Kočka V, Moťovská Z, Widimský P. Patient characteristics, treatment strategy, outcomes, and hospital costs of acute coronary syndrome: 3 years of data from a large high-volume centre in Central Europe. Eur Heart J Suppl 2022; 24:B3-B9. [PMID: 35370502 PMCID: PMC8971736 DOI: 10.1093/eurheartjsupp/suac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Managing patients with acute coronary syndrome (ACS) in an ageing population with comorbidities is clinically and economically challenging. Well-conducted unselected registries are essential for providing information on real-day clinical practice. The aim was to create a long term, very detail-controlled registry of unselected patients admitted with ACS to a high-volume centre in Central Europe. Consecutive patients admitted with confirmed ACS were entered into the prospective registry from 1 October 2018 to 30 September 2021. Data on 214 parameters, including clinical characteristics, angiographic findings, laboratory and therapeutic findings, financial costs, and in-hospital mortality, were obtained for all patients. Analyses were performed on the complete dataset of 1804 patients. Of these patients, 694 (38.5%) were admitted for ST-segment elevation myocardial infarction (STEMI) and 1110 (61.5%) were admitted for non-ST-elevation (NSTE)-ACS [779 with NSTE myocardial infarction (NSTE-MI) and 331 with unstable angina (UA)]. Almost all patients (99%) underwent coronary angiography. Primary percutaneous coronary intervention (PCI) was performed in 93.4% of STEMI patients and 74.5% of NSTE-ACS patients. Patients with NSTE-MI had the longest total hospital stay (8.1 ± 9.1 days) and highest financial costs (8579.5 ± 7173.2 euros). In-hospital mortality was 1.2% in UA, 6.2% in NSTE-MI, and 10.9% in STEMI patients. Age older than 75 years, pre-hospital cardiac arrest and/or mechanical ventilation, subacute STEMI, and ejection fraction below 40% were the most powerful predictors of in-hospital mortality as assessed by multivariate analyses. The in-hospital mortality of unselected NSTE-MI and STEMI patients in daily practice is not low despite very good implementation of guideline-recommended therapy with a high rate of revascularization. The highest financial costs are associated with NSTE-MI.
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Affiliation(s)
- Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - David Bauer
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Markéta Nováčková
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Mašek
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Petr Tu Ma
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Zuzana Moťovská
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Widimský
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
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