The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Abstract

Aims The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. Methods and results From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66–0.94) and revascularisation (RR 0.73, 95% CI 0.62–0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10–1.37) and heart failure (RR 1.08, 95% CI 1.04–1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. Conclusions There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.

Electrocardiographic findings and prognostic values in patients hospitalised with COVID-19 in the World Heart Federation Global Study

“…27 During the pandemic, cardiovascular hospitalisations and procedures have decreased at a cost of increased cardiovascular mortality with greater disparities in LMICs. 28 These are all striking pieces of information that, taken together, point to a direction in which COVID-19 and CVD are more intimately related than we have accounted for at the beginning of the pandemic. We can also notice a bidirectional effect of both COVID-19 causing CVD and being aggravated by it.…”

World Heart Federation Cholesterol Roadmap 2022

“…Those most at risk for ASCVD because of obesity, hypertension, diabetes, and dyslipidaemia were particularly vulnerable to the virus. There has also been a loss of connection for many patients with their healthcare providers, leading to reduced screening, delay in diagnosis and loss of control of these chronic risk factors [3]. This will have ripple effects in ASCVD disease incidence for years to come.…”

Outpatient versus inpatient intravenous diuretic therapy for heart failure in the United States

“…frequency and patterns of outpatient versus inpatient administration of IV diuretic therapy for HF in contemporary clinical practice. Moreover, during phases of the coronavirus disease 2019 (COVID‐19) pandemic, many health systems observed marked declines in hospitalizations for cardiovascular conditions (including HF), and the potential impact of the pandemic on the relative use of an outpatient IV diuretic care strategy for worsening HF is unknown 5,6 . In this context, the objectives of the current analysis were: (i) to characterize the relative frequency of outpatient versus inpatient patient encounters for HF with reduced ejection fraction (HFrEF) using IV diuretics in the US, including temporal changes before and during the COVID‐19 pandemic; and (ii) to assess patterns of subsequent IV diuretic encounters following an index outpatient versus inpatient IV diuretic encounter.…”