Impact of COVID-19 Pandemic on Critical Care Transfers for ST-Segment–Elevation Myocardial Infarction, Stroke, and Aortic Emergencies

Khot, Umesh N.; Reimer, Andrew P.; Brown, Abigail S.; Hustey, Fredric M.; Hussain, Muhammad Shazam; Kapadia, Samir; Svensson, Lars G.

doi:10.1161/circoutcomes.120.006938

Cited by 31 publications

(25 citation statements)

References 3 publications

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“…Notably, the authors observed a significant reduction in the number of ruptured and symptomatic aortic aneurysms. These findings are in line with those of most authors, who reported a substantial and precipitous drop in the monthly surgical case volume in emergency [22] . El-Hamamsy et al [23] declared a 76.5% reduction (12.8 ± 4.6 cases/month before COVID-19 to 3.0 ± 1.0 cases/month after COVID-19; P = .007) in hospitalizations for type A dissection in New York during March and April 2020.…”

Section: Resultssupporting

confidence: 92%

Impact of COVID-19 on aortic operations

Bissacco

Franchin

Piffaretti

et al. 2021

Seminars in Vascular Surgery

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The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19–related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general “non-COVID-19” population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19–positive from COVID-19–negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19–related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.

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Section: Resultssupporting

confidence: 92%

Impact of COVID-19 on aortic operations

Bissacco

Franchin

Piffaretti

et al. 2021

Seminars in Vascular Surgery

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“…Of note, pacemaker implantations following aortic valve interventions were excluded in this analysis indicating a true reduction of emergency admission for severe bradycardia. Interestingly, even in the field of acute aortic syndromes requiring surgery there were marked decreases in patient numbers reported from both Europe to the US 32,33 . Regardless of this, treatment numbers in cardiac surgery were reduced by ~50% up to 75% both in areas with low and even pronounced in those with high COVID‐19 case numbers 34 .…”

Section: Discussionmentioning

confidence: 99%

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

König

Ueberham

Pellissier

et al. 2021

Clinical Cardiology

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Background Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID‐19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long‐term course of hospital admission numbers, (b) provide data for in‐ and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures. Methods and Results Administrative data of patients with ICD‐10‐encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in‐ or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS‐codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of −10% to −16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in‐ and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: −10%; cardiac electronic device implantations: −7%; percutaneous cardiovascular interventions: −9%; cardiovascular surgery: −15%). Conclusions This study provides data on the long‐term development of cardiovascular patient care during the COVID‐19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.

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“…2A). Diverse hospitals reported increasing levels of patients affected by stroke during SARS-CoV-2 infection [129,130]. Klok and colleagues observed disturbing increases in the incidence of thrombotic complications in critically ill intensive care unit patients as high as 31% and recommended pharmacological prophylaxis against thrombosis [24].…”

Section: P2x7 Receptors In Bbb Permeabilitymentioning

confidence: 99%

Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology

et al. 2020

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Scientists and health professionals are exhaustively trying to contain the coronavirus disease 2019 (COVID-19) pandemic by elucidating viral invasion mechanisms, possible drugs to prevent viral infection/replication, and health cares to minimize individual exposure. Although neurological symptoms are being reported worldwide, neural acute and long-term consequences of SARS-CoV-2 are still unknown. COVID-19 complications are associated with exacerbated immunoinflammatory responses to SARS-CoV-2 invasion. In this scenario, pro-inflammatory factors are intensely released into the bloodstream, causing the so-called “cytokine storm”. Both pro-inflammatory factors and viruses may cross the blood–brain barrier and enter the central nervous system, activating neuroinflammatory responses accompanied by hemorrhagic lesions and neuronal impairment, which are largely described processes in psychiatric disorders and neurodegenerative diseases. Therefore, SARS-CoV-2 infection could trigger and/or worse brain diseases. Moreover, patients with central nervous system disorders associated to neuroimmune activation (e.g. depression, Parkinson’s and Alzheimer’s disease) may present increased susceptibility to SARS-CoV-2 infection and/or achieve severe conditions. Elevated levels of extracellular ATP induced by SARS-CoV-2 infection may trigger hyperactivation of P2X7 receptors leading to NLRP3 inflammasome stimulation as a key mediator of neuroinvasion and consequent neuroinflammatory processes, as observed in psychiatric disorders and neurodegenerative diseases. In this context, P2X7 receptor antagonism could be a promising strategy to prevent or treat neurological complications in COVID-19 patients.

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Impact of COVID-19 Pandemic on Critical Care Transfers for ST-Segment–Elevation Myocardial Infarction, Stroke, and Aortic Emergencies

Cited by 31 publications

References 3 publications

Impact of COVID-19 on aortic operations

Impact of COVID-19 on aortic operations

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology

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