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Acute cardiovascular hospitalizations and illness severity before and during the COVID-19 pandemic
Vishal N Rao1,2, Michelle D Kelsey1,2, Anita M Kelsey1
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
Insights
During COVID-19, shelter-in-place orders reduced cardiovascular disease (CVD) hospitalizations, especially heart failure (HF). While HF severity showed minor changes, in-hospital mortality remained stable, indicating no significant increase in risk for acute CVD events.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Global decline in cardiovascular disease (CVD) hospitalizations observed during the COVID-19 pandemic.
- Uncertainty regarding the specific impact of shelter-in-place orders on acute CVD hospitalizations, illness severity, and patient outcomes.
Purpose of the Study:
- To investigate the association between COVID-19 shelter-in-place orders and acute CVD hospitalizations (heart failure [HF], acute coronary syndrome [ACS], stroke [CVA]).
- To assess changes in HF illness severity and in-hospital mortality following the implementation of shelter-in-place mandates.
Main Methods:
- Comparative analysis of acute CVD hospitalizations at Duke University Health System before and after North Carolina's shelter-in-place order (March 30, 2020).
- Utilized parallel 2019 cohorts for comparison.
- Assessed HF illness severity using ADHERE and GWTG-HF risk scores and echocardiography parameters.
Main Results:
- A decrease in mean daily CVD hospitalizations (18.2 to 16.1) and length of stay was observed post-shelter-in-place, with no significant change in in-hospital mortality.
- HF hospitalizations decreased (9.0 to 7.7 per day), with a higher proportion of high-risk ADHERE scores (2.5% to 4.5%) but unchanged GWTG-HF risk.
- Echocardiography revealed lower mean left ventricular ejection fraction (LVEF) and higher mean left ventricular (LV) mass.
Conclusions:
- The COVID-19 shelter-in-place order correlated with reduced acute CVD hospitalizations, particularly for HF.
- No significant increase in in-hospital mortality was detected.
- Minor differences in HF illness severity and echocardiographic measures were noted, suggesting a complex impact of the pandemic on cardiovascular care.
Background:
Cardiovascular disease (CVD) hospitalizations declined worldwide during the COVID-19 pandemic. It is unclear how shelter-in-place orders affected acute CVD hospitalizations, illness severity, and outcomes.
Hypothesis:
COVID-19 pandemic was associated with reduced acute CVD hospitalizations (heart failure [HF], acute coronary syndrome [ACS], and stroke [CVA]), and worse HF illness severity.
Methods:
We compared acute CVD hospitalizations at Duke University Health System before and after North Carolina's shelter-in-place order (January 1-March 29 vs. March 30-August 31), and used parallel comparison cohorts from 2019. We explored illness severity among admitted HF patients using ADHERE ("high risk": >2 points) and GWTG-HF (">10%": >57 points) in-hospital mortality risk scores, as well as echocardiography-derived parameters.
Results:
Comparing hospitalizations during January 1-March 29 (N = 1618) vs. March 30-August 31 (N = 2501) in 2020, mean daily CVD hospitalizations decreased (18.2 vs. 16.1 per day, p = .0036), with decreased length of stay (8.4 vs. 7.5 days, p = .0081) and no change in in-hospital mortality (4.7 vs. 5.3%, p = .41). HF hospitalizations decreased (9.0 vs. 7.7 per day, p = .0019), with higher ADHERE ("high risk": 2.5 vs. 4.5%; p = .030), but unchanged GWTG-HF (">10%": 5.3 vs. 4.6%; p = .45), risk groups. Mean LVEF was lower (39.0 vs. 37.2%, p = .034), with higher mean LV mass (262.4 vs. 276.6 g, p = .014).
Conclusions:
CVD hospitalizations, HF illness severity, and echocardiography measures did not change between admission periods in 2019. Evaluating short-term data, the COVID-19 shelter-in-place order was associated with reductions in acute CVD hospitalizations, particularly HF, with no significant increase in in-hospital mortality and only minor differences in HF illness severity.
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