The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review

Abstract

Background The COVID-19 pandemic has disrupted healthcare services around the world, which may have serious implications for the prognosis of patients with acute cardiovascular disease. We conducted a systematic review to assess the extent to which health services related to the care and management of acute cardiovascular events have been impacted during the COVID-19 pandemic. Methods PubMed, MedRxiv and Google Scholar were searched for observational studies published up to August 12, 2020 for studies that assessed the impact of the pandemic on the care and management of people with acute CVD. Results In total, 27 articles were included. Of these, 16 examined the impact on acute coronary syndromes (ACS), eight on strokes, one on ACS and strokes, and 2 on other types of CVD. When comparing the COVID-19 period to non-COVID-19 periods, eleven studies observed a decrease in ACS admissions ranging between 40 and 50% and five studies showed a decrease in stroke admissions of between 12 and 40%. Four studies showed a larger reduction in non-ST-segment elevation myocardial infarctions (NSTEMI) compared to ST-segment elevation myocardial infarctions (STEMI). A decrease in the number of reperfusion procedures, a shortening in the lengths of stay at the hospital, and longer symptom-to-door times were also observed. Conclusions The COVID-19 pandemic has led to a substantial decrease in the rate of admissions for acute CVD, reductions in the number of procedures, shortened lengths of stay at the hospital and longer delays between the onset of the symptoms and hospital treatment. The impact on patient’s prognosis needs to be quantified in future studies.

Effect of a virtual self‐management intervention for atrial fibrillation during the outbreak of COVID‐19

“…While robust data are lacking, preliminary findings from this study suggest that patients with AF patients are more likely to get information about COVID‐19 from television news shows rather than their medical providers which may have, in part, contributed to the high rates of misinformation about COVID‐19 reported at baseline. There has also been speculation that patients may delay or forgo care for acute cardiovascular symptoms during the pandemic due to fear of infection or receiving inadequate care at the hosptial 36 . Data from our study suggests that while the majority of patients in this sample would seek emergency care for acute cardiovascular symptoms, a significant proportion of patients were afraid that they would receive suboptimal care.…”

COVID-19-Pandemie

“…In einer Metaanalyse von 27 internationalen Studien, von denen 16 die Effekte auf das ACS untersuchten, zeigte sich eine Abnahme von Krankenhauseinweisungen wegen ACS um 40–50 % [ 24 ].…”

“…In einer Metaanalyse von 27 internationalen Studien, wovon 16 spezifisch das ACS analysierten, zeigte sich eine Zunahme des Intervalls zwischen Symptombeginn und Aufnahme beim Herzinfarkt [ 24 ]. Dies dürfte mit dem längeren Warten der Patienten bis zum Notruf zu erklären sein.…”

“…[ 11 ] USA 10.289 NSTEMI und 4955 STEMI Anstieg der Mortalität beim STEMI (OR: 1,52; 95 %-KI: 1,02–2,26), nicht beim NSTEMI (OR: 1,14; 95 %-KI: 0,86–1,53) Kiss et al. [ 24 ] 10 Registerstudien weltweit 50.123 STEMI Patienten Kein signifikanter Einfluss auf die Kurzzeitsterblichkeit (4,8 % [COVID-19] vs. 5,5 % [vor COVID-19]) OR „ odds ratio“, KI Konfidenzintervall, UK United Kingdom, MINAP Myocardial Ischaemia National Audit Project, STEMI „ST segment elevation myocardial infarction“, NSTEMI „non ST segment elevation myocardial infarction“, PCI perkutane Koronarintervention, COVID-19 „coronavirus disease 2019“ …”

“…In der oben genannten internationalen Metaanalyse mit Einschluss von 16 Studien zum ACS ergab sich in mehreren Ländern eine höhere Infarktsterblichkeit während der Monate von März bis Mai [ 24 ]. Eine Gesamtanalyse zur Mortalität für alle 16 ACS-Studien liefert diese Metaanalyse allerdings nicht.…”