INCREASED INPATIENT MORTALITY FOR CARDIOVASCULAR PATIENTS DURING THE FIRST WAVE OF THE COVID-19 EPIDEMIC IN NEW YORK

Background

The acuity and magnitude of the first wave of the COVID-19 epidemic in New York mandated a drastic change in health care access and delivery of care whose effects have yet to be fully evaluated.

Methods

We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11^th through May 26^th 2020 (COVID-19 era) and same period in 2019.

Results

3016 patients (242 with COVID-19 positive PCR) were admitted for an acute cardiovascular syndrome during COVID-19 era compared to 9,422 patients one year prior (decrease of 68.0%, p < 0.001). COVID-19 era patients presented later to the hospital (360 vs 162 min for acute myocardial infarction), underwent less procedures (34.6% vs 45.6%, p<.001), were less likely to be treated in an ICU setting (8.7% vs 10.8%, p<.001) and had a longer hospital stay (5.0±5.7 vs 4.3±5.2 days, p<0.001). In-patient cardiovascular mortality at Northwell during COVID-19 era increased by 111.1% (3.8 vs. 1.8, p< 0.001) and was not related to COVID-19 related admissions, all cause in-hospital mortality or incidence of out-of-hospital cardiac deaths in New York.

Conclusion

A lower rate and later presentation of patients with cardiovascular pathology coupled with a deviation from common clinical practice mandated by the first wave of the COVID-19 pandemic might have accounted for higher in-hospital cardiovascular mortality.