Collateral effect of the COVID-19 pandemic on cardiology service provision and cardiovascular mortality in a population-based study: COVID-COR-LT

Jelena Čelutkienė, Kamilė Čerlinskaitė-Bajorė, Vilhelmas Bajoras, Rasa Višinskienė, Mindaugas Lizaitis, Povilas Budrys, Romualdas Buivydas, Romualdas Gurevičius, Pranas Šerpytis, Giedrius Davidavičius, Jelena Čelutkienė, Kamilė Čerlinskaitė-Bajorė, Vilhelmas Bajoras, Rasa Višinskienė, Mindaugas Lizaitis, Povilas Budrys, Romualdas Buivydas, Romualdas Gurevičius, Pranas Šerpytis, Giedrius Davidavičius

Abstract

Background: Collateral damage of the COVID-19 pandemic on cardiovascular health is increasingly studied. This is a population-based study addressing multiple aspects of cardiovascular care during the pandemic in a country of Lithuania, in which pandemic waves were significantly different.

Methods: Data on cardiology outpatient care, hospitalizations and cardiovascular mortality in 2019 and 2020 were collected from Lithuanian nationwide administrative databases and registries. Weekly data and aggregated numbers of corresponding 6-week phases were analyzed comparing the numbers between 2019 and 2020. Age, sex and regional subgroup analysis was performed.

Results: Both cardiovascular outpatient care visits and hospitalizations decreased dramatically in 2020 compared to 2019 with a peak reduction (up to - 60% for both) during the first pandemic wave in spring of 2020. Simultaneously, cardiovascular mortality was much higher in 2020, with a pronounced peak at the end of the year compared to 2019 (up to 46%). The increase was even more staggering when analyzing home deaths, which rose up to 91% by the end of 2020. Notable differences between age groups, regions and sexes were documented.

Conclusion: A profound indirect damage of COVID-19 pandemic on cardiovascular care was observed in this study, with striking decreases in cardiovascular care provision and concurrent increase in cardiovascular mortality, both overall and, even more dramatically, at home.

Trial registration: ClinicalTrials.gov: NCT05021575 (registration date 25-08-2021, retrospectively registered).

Keywords: COVID-19; Cardiovascular mortality; Collateral effect; Population health.

Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Figures

Fig. 1
Fig. 1
Comparison of numbers of outpatient cardiovascular visits in Lithuania in 2019 and 2020. A Weekly variations of the outpatient cardiovascular visits. Vertical reference lines denote important dates of the pandemic in Lithuania. B Number of outpatient cardiovascular visits in 6-week periods before, during and after quarantine
Fig. 2
Fig. 2
Comparison of the weekly numbers of primary, secondary, and tertiary cardiovascular outpatient visits in Lithuania in 2019 and 2020. Vertical reference lines denote important dates of the pandemic in Lithuania
Fig. 3
Fig. 3
Comparison of numbers of cardiovascular hospitalizations in Lithuania in 2019 and 2020. A Weekly variations of the cardiovascular hospitalizations. Vertical reference lines denote important dates of the pandemic in Lithuania. B Number of cardiovascular hospitalizations in 6-week periods before, during and after quarantine
Fig. 4
Fig. 4
Percentage change of cardiovascular services in different districts of Lithuania during the first quarantine compared to 2019. A Total outpatient visits. B Primary outpatient visits. C Secondary and tertiary outpatient visits. D Hospitalizations
Fig. 5
Fig. 5
Comparison of rate of cardiovascular mortality in Lithuania in 2019 and 2020. A Weekly variations of cardiovascular deaths. Vertical reference lines denote important dates of the pandemic in Lithuania. B Cardiovascular deaths in 6-week periods before, during and after quarantine
Fig. 6
Fig. 6
Places of cardiovascular deaths in Lithuania in 2019 and 2020. A Weekly variations of cardiovascular deaths at home. Vertical reference lines denote important dates of the pandemic in Lithuania. B Places of cardiovascular deaths in the periods in 6-week periods before, during and after quarantine
Fig. 7
Fig. 7
Comparison of weekly cardiovascular hospitalizations and in-hospital mortality in Lithuania between 2019 and 2020
Fig. 8
Fig. 8
Changes in cardiovascular services in different age groups during the first quarantine compared to 2019. A Out-patient visits. B Hospitalizations
Fig. 9
Fig. 9
Changes in cardiovascular mortality rate in different age groups during the first quarantine compared to 2019
Fig. 10
Fig. 10
Difference in cardiovascular mortality in Lithuania by sex in 2020 compared to 2019. A Weekly variations of cardiovascular deaths in men and women. B Weekly variations of cardiovascular deaths at home in men and women. Vertical reference lines denote important dates of the pandemic in Lithuania

References

    1. Ball S, Banerjee A, Berry C, Boyle JR, Bray B, Bradlow W, Chaudhry A, Crawley R, Danesh J, Denniston A, Falter F, Figueroa JD, Hall C, Hemingway H, Jefferson E, Johnson T, King G, Lee KK, McKean P, Mason S, Mills NL, Pearson E, Pirmohamed M, Poon MTC, Priedon R, Shah A, Sofat R, Sterne JAC, Strachan FE, Sudlow CLM, Szarka Z, Whiteley W, Wyatt M, CVD-COVID-UK Consortium Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK. Heart Br Card Soc. 2020;106:1890–1897. doi: 10.1136/heartjnl-2020-317870.
    1. Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes. 2021;7:18–27. doi: 10.1093/ehjqcco/qcaa084.
    1. Andersson C, Gerds T, Fosbøl E, Phelps M, Andersen J, Lamberts M, Holt A, Butt JH, Madelaire C, Gislason G, Torp-Pedersen C, Køber L, Schou M. Incidence of new-onset and worsening heart failure before and after the COVID-19 epidemic lockdown in Denmark: a nationwide cohort study. Circ Heart Fail. 2020;13:e007274. doi: 10.1161/CIRCHEARTFAILURE.120.007274.
    1. Brant LCC, Nascimento BR, Teixeira RA, Lopes MACQ, Malta DC, Oliveira GMM, Ribeiro ALP. Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities. Heart Br Card Soc. 2020;106:1898–1905. doi: 10.1136/heartjnl-2020-317663.
    1. Coronavirus Disease (COVID-19) Situation Reports. . Accessed 25 Jul 2021
    1. Lithuania: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data. . Accessed 25 Jul 2021
    1. Wosik J, Clowse MEB, Overton R, Adagarla B, Economou-Zavlanos N, Cavalier J, Henao R, Piccini JP, Thomas L, Pencina MJ, Pagidipati NJ. Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care. Am Heart J. 2021;231:1–5. doi: 10.1016/j.ahj.2020.10.074.
    1. Impact COVID Outpatient Care: Visits Prepandemic Levels but Not All | Commonwealth Fund. . Accessed 25 Jul 2021
    1. Baum A, Kaboli PJ, Schwartz MD. Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Ann Intern Med. 2021;174:129–131. doi: 10.7326/M20-3026.
    1. Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3:e2021476. doi: 10.1001/jamanetworkopen.2020.21476.
    1. Bhatt AS, Moscone A, McElrath EE, Varshney AS, Claggett BL, Bhatt DL, Januzzi JL, Butler J, Adler DS, Solomon SD, Vaduganathan M. Fewer hospitalizations for acute cardiovascular conditions during the COVID-19 pandemic. J Am Coll Cardiol. 2020;76:280–288. doi: 10.1016/j.jacc.2020.05.038.
    1. Enache B, Claessens Y-E, Boulay F, Dor V, Eker A, Civaia F, Pathak A. Reduction in cardiovascular emergency admissions in Monaco during the COVID-19 pandemic. Clin Res Cardiol Off J Ger Card Soc. 2020;109:1577–1578. doi: 10.1007/s00392-020-01687-w.
    1. Seidu S, Kunutsor SK, Cos X, Khunti K. Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: a systematic review. Prim Care Diabetes. 2021;15:653–681. doi: 10.1016/j.pcd.2021.05.011.
    1. Baum A, Schwartz MD. Admissions to veterans affairs hospitals for emergency conditions during the COVID-19 pandemic. JAMA. 2020;324:96–99. doi: 10.1001/jama.2020.9972.
    1. Seiffert M, Brunner FJ, Remmel M, Thomalla G, Marschall U, L’Hoest H, Acar L, Debus ES, Blankenberg S, Gerloff C, Behrendt C-A. Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims. Clin Res Cardiol Off J Ger Card Soc. 2020;109:1540–1548. doi: 10.1007/s00392-020-01723-9.
    1. Wu J, Mamas MA, Mohamed MO, Kwok CS, Roebuck C, Humberstone B, Denwood T, Luescher T, de Belder MA, Deanfield JE, Gale CP. Place and causes of acute cardiovascular mortality during the COVID-19 pandemic. Heart Br Card Soc. 2021;107:113–119. doi: 10.1136/heartjnl-2020-317912.
    1. Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, Dörr O, CoVCAD –Study Group Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol Off J Ger Card Soc. 2021;110:292–301. doi: 10.1007/s00392-020-01780-0.
    1. Wadhera RK, Shen C, Gondi S, Chen S, Kazi DS, Yeh RW. Cardiovascular deaths during the COVID-19 pandemic in the United States. J Am Coll Cardiol. 2021;77:159–169. doi: 10.1016/j.jacc.2020.10.055.
    1. Tsioufis K, Chrysohoou C, Leontsinis I, Tousoulis D. Unveiling the mystery of “missing” emergencies in the era of COVID-19 pandemic: a generalized phenomenon with unclarified implications. Clin Res Cardiol Off J Ger Card Soc. 2020;109:1580–1581. doi: 10.1007/s00392-020-01700-2.
    1. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S, Lombardia CARe researchers COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. Eur Heart J. 2020;41:3045–3054. doi: 10.1093/eurheartj/ehaa508.
    1. Butt JH, Fosbøl EL, Gerds TA, Andersson C, Kragholm K, Biering-Sørensen T, Andersen J, Phelps M, Andersen MP, Gislason G, Torp-Pedersen C, Køber L, Schou M. All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study. Eur Heart J. 2021;42:1516–1523. doi: 10.1093/eurheartj/ehab028.
    1. Stöhr E, Aksoy A, Campbell M, Al Zaidi M, Öztürk C, Vorloeper J, Lange J, Sugiura A, Wilde N, Becher MU, Diepenseifen C, Heister U, Nickenig G, Zimmer S, Tiyerili V. Hospital admissions during Covid-19 lock-down in Germany: Differences in discretionary and unavoidable cardiovascular events. PLoS ONE. 2020;15:e0242653. doi: 10.1371/journal.pone.0242653.
    1. Mohamed MO, Gale CP, Kontopantelis E, Doran T, de Belder M, Asaria M, Luscher T, Wu J, Rashid M, Stephenson C, Denwood T, Roebuck C, Deanfield J, Mamas MA. Sex differences in mortality rates and underlying conditions for COVID-19 deaths in England and Wales. Mayo Clin Proc. 2020;95:2110–2124. doi: 10.1016/j.mayocp.2020.07.009.
    1. Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, Mendelson MA, Wood MJ, Volgman AS, Mieres JH. Sex differences in ischemic heart disease: advances, obstacles, and next steps. Circ Cardiovasc Qual Outcomes. 2018;11:e004437. doi: 10.1161/CIRCOUTCOMES.117.004437.
    1. Cannatà A, Bromage DI, McDonagh TA. The collateral cardiovascular damage of COVID-19: only history will reveal the depth of the iceberg. Eur Heart J. 2021;42:1524–1527. doi: 10.1093/eurheartj/ehab097.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever