Increased cardiovascular death rates in a COVID-19 low prevalence area

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The COVID-19 pandemic impacted healthcare utilization globally.
• Central Italy's L'Aquila province experienced minimal direct COVID-19 effects but observed changes in patient behavior.
• Understanding these behavioral shifts is crucial for public health preparedness.

Purpose of the Study:

• To analyze changes in all-cause and cardiovascular hospitalizations and treatments in L'Aquila.
• To compare cardiovascular mortality rates before and during the early pandemic period.
• To investigate potential alterations in healthcare-seeking behaviors due to the pandemic.

Main Methods:

• Retrospective analysis of de-identified hospitalization and treatment data from L'Aquila (Jan 1 - Mar 31, 2019 vs. 2020).
• Inclusion of data on all-cause, cardiovascular hospitalizations, acute cardiovascular treatments, and in-hospital deaths.
• Statistical comparison using Incidence Rate Ratios (IRR) via Poisson regression.

Main Results:

• A significant decrease in all-cause hospitalizations (IRR 0.85) and cardiovascular hospitalizations (IRR 0.73) in 2020 compared to 2019.
• A reduction in daily cardiovascular procedures (IRR 0.74) was observed, with a disproportionate decrease relative to hospitalizations.
• An increase in in-hospital cardiovascular deaths occurred in March 2020 (+6.8%) compared to March 2019, contrasting with all-cause mortality trends.

Conclusions:

• The early COVID-19 pandemic was associated with reduced hospitalizations for cardiovascular conditions in L'Aquila.
• A concerning rise in cardiovascular deaths during March 2020 suggests delayed or forgone care.
• Findings highlight potential negative impacts on cardiovascular health outcomes due to pandemic-related changes in healthcare access and behavior.