REDUCTION IN HOSPITAL ADMISSIONS ASSOCIATED WITH CORONARY EVENTS DURING THE COVID-19 PANDEMIC IN THE BRAZILIAN PRIVATE HEALTH

Background

The COVID-19 pandemic significantly impacted the Brazilian healthcare system, resulting in deferral of elective cardiac procedures and avoidance of medical care due to social distancing. We aimed to evaluate the impact of COVID-19 on hospital admissions and death rates associated with coronary events in a Brazilian large-scale private health system.

Methods

From March 18 - Sep 30, 2020 we evaluated the administrative database of UNIMED-BH, a cooperative Brazilian private insurance, with over 1.25 million clients from a large urban center. We collected data from admissions in all owned and accredited hospitals related to urgent and elective coronary events (acute coronary syndromes, coronary interventions, clinical management of coronary artery disease and invasive diagnostic procedures). Admissions in 2020 were compared to the 2-year historical series (2018, 2019), and rates/100,000 were calculated considering the mean covered population. Outcomes were assessed until October 15^th, 15 days after the last enrollment.

Results

In the 196-day period, the number of coronary admissions in 2018, 2019 and 2020 were, respectively, 2,789, 3,519 and 2,348, and patients had a median age of 67 [58-76] years, being 59% men. The mean length of hospital stay was 6.7±9.3 days, and 27% had >1 admission in 3 years. The adjusted rates of admissions were 221, 278 and 184/100,000 clients, resulting in a significant 26% (95% CI 22 - 30) reduction in 2020 compared to the historical series (p<0.001). The reduction was more pronounced from March to May (36%) - when social isolation started - compared to the peak of the pandemic (June to September, 19%). In-hospital mortality was also significantly higher in 2020 (5.4%, 95% CI 4.5 - 6.4) compared to 2018/2019 (3.6%, 95% CI 3.2 - 4.1), p<0.001, despite the similar age (67 [57-76) vs. 67 [58-76], p=0.15) and length of hospital stay (6.9±8.9 vs. 6.7±9.5 days, p=0.43).

Conclusion

There was a significant decrease in admissions due to coronary events during the COVID-19 pandemic in Brazil, in parallel with increased in-hospital mortality. Deferral of elective procedures and avoidance of medical care possibly resulted in delayed presentation and unfavorable outcomes.