Admissions and In-hospital Outcomes of Acute Coronary Syndromes during Corona Virus Disease 19 Pandemic in Albania

Abstract

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%; weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0; p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%; weekly MID 7.3 [0.6-15.2]; p = 0.048]; NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4]; p < 0.001]. Invasive procedures were also reduced: coronary angiography by 42.5%, weekly MID 26.6 [13.4-39.2]; p = 0.001]; percutaneous coronary intervention (PCI) by 42.3%, weekly MID 16.1 [5.9-26.3], p = 0.004]. Compared to 2019, during the COVID-19 period, there was a 2.4 fold increase in the inhospital death (3% vs 7.2%) with a significant weekly MID 1.4 [0.2-2.7) P=0.032]. A 2.6-fold increase in the occurrence of cardiogenic shock was also observed (13.1% vs. 5.1%, p < 0.0001). CONCLUSIONS: The admissions for ACS and invasive revascularization procedures were significantly reduced, whereas the death rate was increased during COVID 19 pandemic outbreak in Albania compared with the same period in 2019.

Acute coronary syndrome and its treatment outcomes in Ethiopia: a systematic review and meta-analysis

“…In contrast, the proportion of hypertension observed in this systematic review and meta-analysis was lower than in studies done in Slovakia (83.5%) and Albania (90.6%) [ 11 , 14 ]. This variation might be due to lack of diagnostic modalities and proficiency in our setting.…”

“…Even though, there is advancement in diagnosis and management of ACS, still it is the most common cause of death around the globe including in Ethiopia [ 9 , 10 ]. A study done at Addis Cardiac Hospital, Ethiopia showed that among 300 cardiac patients, 162 (53.7%) of them had ACS [ 11 ]. Moreover lower-income countries are facing a double burden of disease because of the higher prevalence of both communicable and non-communicable diseases particularly cardiovascular diseases [ 10 ].…”

“…More than 90% of risk factors are potentially modifiable risk factors using pharmacological and non-pharmacological methods. However, it is difficult to achieve these outcomes in resource-limited countries because of insufficient laboratory setup, lack of reperfusion therapy, cost of medications, and discontinuity of care [11,15,16]. Though several scholars attempted to describe the extent of risk factors, management and in-hospital mortality due to acute coronary syndrome in Ethiopia, there is no a nationwide study on this area; which is an important research gap.…”

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study

“…The first release measures began at the end of April and continued through May, restoring the "normal" life [13]. We previously documented a significant reduction of all-ACS (-41.6%) [14] and STEMI admissions (-28%) [15], and also an increase in mortality for all-ACS with a risk ratio (RR) = 2.2 [(1.20-3.89); p=0.01] and STEMI [RR =1.91 (1.039-3.52) p=0.037] during the lockdown in 2020 compared to the pre-pandemic (PP) period.…”