The COVID-19 Pandemic and Acute Coronary Syndrome Admissions and Deaths in Allegheny County, Pennsylvania
Brandon M Herbert1, Indu G Poornima2, Suresh R Mulukutla3
1Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Insights
The COVID-19 pandemic saw fewer acute coronary syndrome hospitalizations, but increased overall and ischemic heart disease deaths in Allegheny County. Despite these shifts, the long-term declining trends for acute myocardial infarction hospitalizations and IHD deaths remained unchanged.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Understanding its effects on cardiovascular disease trends is crucial for public health planning.
Purpose of the Study:
- To evaluate the pandemic's influence on acute coronary syndrome (ACS) hospitalizations, all-cause mortality, and ischemic heart disease (IHD) mortality in Allegheny County, Pennsylvania.
- To analyze trends across different age groups during the pre-pandemic and pandemic periods.
Main Methods:
- Utilized inpatient hospital records (January 2017-November 2020) for acute myocardial infarction (AMI) and unstable angina.
- Incorporated Pennsylvania Department of Health data for all-cause and IHD deaths.
- Employed interrupted time-series analysis to compare pre-pandemic (January 2017-February 2020) and pandemic (March 2020-November 2020) periods, including age-specific analyses.
Main Results:
- AMI hospitalizations decreased by 14.8% and unstable angina by 30.7% during the pandemic compared to 2019, with the greatest reduction in individuals aged ≥75.
- Total mortality rose by 9.2% and IHD mortality by 2.4%.
- COVID-19 accounted for approximately 80% of the mortality increase, primarily affecting individuals aged ≥75 and long-term care residents.
Conclusions:
- The COVID-19 pandemic did not significantly alter the established downward trend in AMI hospitalizations in Allegheny County.
- Longitudinal declining trends for ischemic heart disease deaths also persisted despite pandemic-related mortality increases.
Abstract:
Background/Objectives: This study evaluated the impact of the COVID-19 pandemic on trends of acute coronary syndrome hospitalizations, all-cause deaths, and ischemic heart disease (IHD) deaths in Allegheny County, Pennsylvania. Methods: Inpatient hospital records from two hospital systems within Allegheny County, Pennsylvania, were aggregated from January 2017 to November 2020. The primary diagnoses were acute myocardial infarction (AMI) and unstable angina. The Pennsylvania Department of Health provided all-cause and IHD death counts for the same period. We compared absolute percentage changes in admissions by year (March-November) and trends by age-specific groups (<45, 45-64, 65-74, ≥75) from the pre-pandemic (January 2017-February 2020) to pandemic (March 2020-November 2020) period using an interrupted time-series analysis. Results: There were 11,913 AMI hospitalizations pre-pandemic and 2170 AMI hospitalizations during the pandemic period. AMI hospitalizations decreased by 14.8% and unstable angina hospitalizations decreased by 30.7% during the pandemic compared to 2019, with the largest decreases occurring in those aged ≥75. Total mortality increased by 9.2%, and IHD mortality increased by 2.4%. About 80% of the increase in deaths was due to COVID-19, and approximately 75% of deaths occurred in those aged ≥75 and in long-term care facility residents. Conclusions: The COVID-19 pandemic did not markedly alter the longitudinal declining trend of AMI hospitalizations and IHD deaths in Allegheny County.
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