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Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction?
Christos S Katsouras1, Michail I Papafaklis2, Sotirios Giannopoulos3,4
12nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece. cskats@yahoo.com.
Insights
The COVID-19 pandemic saw fewer cardiovascular admissions, likely due to collateral damage from public health measures. Healthcare systems must prepare for potential future increases in cardiovascular events.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Observational studies noted a decline in cardiovascular (CV) admissions during the COVID-19 pandemic.
- Recent analyses suggest the initial decrease was overestimated, with causes and impacts remaining unclear.
- Two years into the pandemic, the reasons for reduced CV hospitalizations are still debated.
Purpose of the Study:
- To review the literature on cardiovascular admissions and collateral damage during the COVID-19 pandemic.
- To discuss factors contributing to the decline in CV hospitalizations.
- To highlight the need for healthcare system preparedness for future CV events.
Main Methods:
- Narrative review of published literature.
- Analysis of reporting milestones concerning CV admissions and collateral damage.
- Discussion of potential causes for reduced CV hospitalizations.
Main Results:
- Evidence suggests 'collateral damage' from COVID-19 measures (e.g., social distancing) significantly reduced CV admissions.
- A true decrease in community CV events due to fewer triggers is possible but not confirmed.
- Indirect evidence links collateral damage to excess mortality, with potential late consequences like CV event rebound yet to be observed.
Conclusions:
- The decline in cardiovascular hospitalizations during COVID-19 is primarily attributed to collateral damage from public health interventions.
- Late consequences, including a potential rebound in cardiovascular events, require monitoring.
- Healthcare systems must prepare for increased future cardiovascular hospitalization rates.
Abstract:
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
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