Impact of the First COVID-19 Wave on French Hospitalizations for Myocardial Infarction and Stroke: A Retrospective Cohort Study

Abstract

The COVID-19 pandemic modified the management of myocardial infarction (MI) and stroke. We aimed to evaluate the effect of the COVID-19 pandemic on the volume and spatial distribution of hospitalizations for MI and stroke, before, during and after the first nationwide lockdown in France in 2020, compared with 2019. Hospitalization data were extracted from the French National Discharge database. Patient’s characteristics were compared according to COVID-19 status. Changes in hospitalization rates over time were measured using interrupted time series analysis. Possible spatial patterns of over or under-hospitalization rates were investigated using Moran’s indices. We observed a rapid and significant drop in hospitalizations just before the beginning of the lockdown with a nadir at 36.5% for MI and 31.2% for stroke. Hospitalization volumes returned to those seen in 2019 four weeks after the end of the lockdown, except for MI, which rebounded excessively. Older age, male sex, elevated rate of hypertension, diabetes, obesity and mortality characterized COVID-19 patients. There was no evidence of a change in the spatial pattern of over- or under-hospitalization clusters over the three periods. After a steep drop, only MI showed a significant rebound after the first lockdown with no change in the spatial distribution of hospitalizations.

The Potential Role of Gender in the Incidence, Management, and Outcomes of Stroke in Patients Suffering From COVID-19: A Brief Review

“…The characteristics of the studies from which gender-disaggregated data on stroke under COVID-19 were retrieved are depicted in Table 1. Of the primary studies, five involved samples from the USA [14,15,[17][18][19], four from Europe [20][21][22][23], and two had a global/ international reach [24,25]. All studies employed retrospective cohort designs, with the exception of one cross-sectional study [22].…”

“…To explore differences in gender-specific frequencies of stroke in patients with COVID-19, we assessed evidence from studies in which researchers compared cohorts of patients with stroke/COVID to properly matched either (i) historical cohorts, i.e., pre-pandemic stroke patients of the previous year(s) [ 14 , 17 , 20 ], and/or (ii) contemporary cohorts of patients with stroke but no COVID-19 [ 18 , 19 , 21 , 22 ]. Harrison et al performed a retrospective cohort study using electronic records from 50 healthcare organizations in the USA.…”

“…In a second French study of the impact of the COVID-19 pandemic on myocardial infarction and stroke hospitalizations, comparing data from 2019 to the period surrounding the 2020 nationwide study, significant male predominance was observed. Among patients with stroke/COVID, men represented 58.4%, whereas among non-COVID strokes, their proportion fell to 51.4% of cases [ 21 ]. Both French studies extracted data from the same source, the French National Discharge database.…”

“…Both French studies compared stroke/COVID patients to contemporary stroke patients without COVID-19. However, the study by Mariet et al [ 21 ] confined data analysis regarding the gender gradient to the two lockdown months (March-May 2020), whereas the study by Gabet et al [ 22 ] extended it to the whole study period, that is, January to mid-June 2020. It means that the latter study, apart from a longer enrollment period, included cases from January and February 2020, when COVID-19 cases were scarce.…”

The Peripandemic Impact of the First Wave of the COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China

“…Therefore, the reduced STEMI cases during the outbreak was due to the impact of COVID-19 rather than the seasonality of different study periods. On the contrary, the rebound of AMI was observed in a few countries, even during uncontrolled COVID-19 pandemic periods [43][44][45][46]. A relatively strict policy of staying at home and patients' fear of infection [3,47] may have affected STEMI treatment in China, while some campaigns were adopted to encourage patients with symptoms or signs of AMI to seek immediate medical attention, even amid the pandemic, in several countries [48][49][50].…”