Table 2.
Trends in hospitalisations of cardiometabolic conditions and severity at presentation.
| Author, year of publication | Cardiometabolic condition | Historical control/pre-COVID-19 hospitalisations | Pre-pandemic/pre-lockdown hospitalisations | Pandemic/lockdown hospitalisations | Trends in hospitalisations for cardiometabolic outcomes | Severity of presentation |
|---|---|---|---|---|---|---|
| Araiza-Garaygordobil, 2021 | ACS admissions | 8750 | 5923 | 1444 | Compared to the pre-pandemic period, a significant overall trend for reduction of 20.2% in the weekly number of ACS hospitalizations was observed during the pandemic period. There were also reductions when compared to the historical period. | |
| Mafham, 2020 | ACS admissions | Monthly average for 2019 (13,075); Jan 2020 (13,645); Feb 2020 (12,443) | Mar 2020 (10,118); Apr 2020 (8739); May 2020 (9756) | From mid-February 2020, hospital admissions fell from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020 (reduction of 40%). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% reduction from baseline. | ||
| Perrin, 2020 | Undergoing PCI for ACS | 140 | 45 | The incidence rate of ACS was lower during the COVID-19 period than the control period (0.7 vs 1.1 per 1000 person-years, p < 0.01). There were significantly more patients presenting with out-of-hospital cardiac arrest during the COVID-19 period compared with the control period (22.2% vs 7.1%, p < 0.01). | ACS patients presented higher cardiac enzymes during the COVID-19 period compared with the control period. | |
| Tam, 2020 | MI admissions | 85 | 64 | There was a reduction in daily emergency room attendance since January 25, 2020 (231 per day compared to 327 per day before the pandemic) | ||
| Toniolo, 2020 | Severe emergent CVD admissions | 71 | 34 | A decrease was observed in all SECDs hospital admissions comparing the pandemic to the control period: 27 versus 19 for STE-ACS (−30%); 44 versus 15 for non-STE-ACS (−66%) and 46 versus 23 for atrioventricular-block/acute sinus node dysfunction (−50%). | ||
| Huet, 2020 | Acute myocardial infarction or acute heart failure admissions | Before containment, the nine participating intensive cardiac care units admitted 4.8 ± 1.6 patients per day, versus 2.6 ± 1.5 after containment. | ||||
| Kwok, 2020b | PCI procedures for STEMI | 33,255 | 683 | A 43% decline in monthly average procedures was recorded between 2017 and 2019 (865) to 497 in April 2020 | ||
| Boukhris, 2020 | Volume of ACS and ischemic strokes | ACS (2398); ischemic stroke (4027) | ACS (2215); ischemic stroke (3905) | ACS volume tended to increase in January and February 2020 in comparison to the same period in 2019. In March and April 2020, STEMI and NSTEMI decreased in comparison with March and April 2019. There was a gradual decrease in stroke cases from January to March 2020 compared to 2019, followed by an increase in April 2020. | ||
| Braiteh, 2020 | ACS admissions | 113 | 67 | Drop by 40.7% in total ACS cases during the pandemic in comparison to 2019 | ||
| Butt, 2020 | ACS, other CVDs, stroke | ACS (171); other CVDs (116); stroke (109) | March 2020 - ACS (114); other CVDs (64); stroke (83) | Compared to March 2019, there was a decrease in ACS, other CVDs, and stroke by 50%, 81.3% and 31.3% respectively, in March 2020 | ||
| De Filippo, 2020 | ACS admissions | ACS (756) | ACS (899) | ACS (547) | 13.3 ACS admissions/day during the pandemic period compared to 18.0 for the pre-pandemic period and 18.9 for the historical period. The corresponding values for STEMI were 6.1, 7.8 and 8.0. That for NSTEMI were 4.2, 7.1 and 7.5. Unstable angina was 3.1, 3.1 and 3.4. | |
| De Rosa, 2020 | AMI admissions | AMI (618); STEMI (268); NSTEMI (350) | AMI (319); STEMI (197); NSTEMI (122) | 48.4% reduction in AMI admissions during the pandemic period compared to 2019. Reductions were significant for both STEMI and NSTEMI. The reductions for STEMIs were higher for women compared to men. Reductions in admissions for HF, AF and PE during the pandemic compared to 2019. | ||
| Fileti, 2020 | ACS admissions | ACS (94); STEMI (36); NSTEMI (58) | ACS (72); STEMI (34); NSTEMI (38) | 23.4% reduction in ACS admissions during 2020 compared to 2019, with a decrease for both STEMI and NSTEMI | ||
| Folino, 2020 | Access to coronary care unit for ACS | NSTEMI in first 8 weeks of 2019 (260) and 221 in the following 5 weeks. Corresponding values for STEMI were 22 and 21 | After the eighth week of 2020, there was a significant reduction in access to CCU for NSTEMI compared to the same period of the previous year, but not for STEMI. | |||
| Haddad, 2020 | STEMI admissions | 60 | 54 | 53 | Number of STEMI admissions were unaffected during the pandemic period | |
| Hauguel-Moreau, 2020 | ACS admissions | In 2020, there were two distinct phases in ACS admissions - a first significant fall, with a relative reduction of 73%, from the week of lockdown (week 12) to 3 weeks later followed by an increase | ||||
| Holy, 2020 | ACS and OHCA referrals | Four weeks after March 16th 2020 ACS referrals decreased by 42% (NSTEMI: –49%, STEMI: –56%, unstable angina: +37%) while OHCA referrals declined by 57% | ||||
| Metzler, 2020 | ACS admissions | Comparing the first and last calendar week of the period surveyed, there was a relative reduction of 39.4% in admissions for ACS. STEMI admissions reduced from 94 to 70 and NSTEMI from 132 to 67 | ||||
| Montagnon, 2021 | Admissions for ACS and strokes | ACS (12); Stroke or TIA (27) | ACS (7); Stroke or TIA (30) | There were five fewer cases of ACS in 2020, a reduction of 41.7% compared with 2019. In 2020, an increase was observed in the number of strokes and TIAs, with 27 cases in 2019 as opposed to 30 in 2020. | ||
| Showkathali, 2020 | ACS admissions | 183 | 104 | During the study period in 2020, 104 patients were admitted with ACS, which is a 43% decline in admissions compared to the same time period in the previous 2 years (183). The decline in STEMI, NSTEMI and unstable angina admissions were 47%, 33%, and 54% respectively | ||
| Sokolski, 2020 | Cardiovascular admissions | 4452 | 3007 | In 2020, there were fewer admissions for ACS, acute HF, arrhythmia, and others. There was a relatively higher percentage of pulmonary embolism admissions in 2020 | ||
| Solomon, 2020 | AMI admissions | The weekly rates of hospitalization for AMI decreased by up to 48% during the Covid-19 period | ||||
| Vacanti, 2020 | ACS admissions | 2018 (326); 2019 (353) | 270 | Decline in ACS admissions in 2020 compared to 2019 and 2018, representing a decline of 24% and 19%, respectively. | ||
| Yalamanchi, 2020 | ACS admissions | 2018 (307); 2019 (322) | 216 | Decline in ACS admissions in 2020 compared to 2019 and 2018, representing a decline of 33% and 30%, respectively.There was a decline in admissions for acute decompensated heart failure, arrhythmia, and other diagnoses in 2020, which were 38%, 62%, and 59%, respectively; while there was a 50% increase in acute pulmonary embolism admission compared to the mean admission in 2018 and 2019 | ||
| Tsioufis, 2020 | AMI admissions | The number of AMI cases in March 2020 was the lowest compared to the entire three year period. Similar significant findings were observed for STEMI and NSTEMI. Cases of HF and CAD were also lower in 2020 compared to the preceeding periods | ||||
| Gasior, 2020 | AMI admissions | The number of admissions for AMI dropped on average by 43.6% | ||||
| Dreger, 2020 | AMI admissions | 2017 (255); 2018 (250); 2019 (257) | 207 | There was a reduction in AMI admissions in 2020 compared with the same time period in the three previous years. | ||
| Anderson, 2020 | Admissions for cardiometabolic conditions | Overall decrease in cardiometabolic conditions (CVD, strokes, VTE, HF and diabetes) | ||||
| Gluckman, 2020 | AMI admissions | 13,329 | Early COVID-19 period (860) | Later COVID-19 period (1055) | Beginning February 23, 2020, AMI-associated hospitalizations decreased for 5 weeks (early COVID-19 period). Thereafter, AMI-associated hospitalizations increased during the later COVID-19 period | |
| Mohammad, 2020 | MI cases referred for coronary angiography | 15,213 | 2443 | The incidence of MI referred for invasive treatment was reduced during the COVID-19 pandemic | ||
| Piccolo, 2020 | PCI procedures for ACS | 178 cases/100,000 residents per year | 120/100,000 residents per year | During the 8 week period, there was a decline by 32% in the number of PCIs for ACS. In the last 2 weeks of the observational period, PCIs for ACS were reduced by 50%. The reduuction was similar for STEMI and NSTEMI | ||
| Secco, 2020 | ACS admissions | 162 | 84 | Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020 | ||
| Ayad, 2021 | STEMI patients requiring PCI | 364 | 270 | During the COVID-19 period, the number of PCI procedures was reduced by 25.7% compared with previous year | ||
| Bhatt, 2020 | Acute cardiovascular conditions | 404 | 231 | There were 43.4% fewer estimated daily hospitalizations in March 2020 compared with March 2019 | ||
| Daoulah, 2021 | STEMI admissions | 2018 (650); 2019 (635) | 500 | STEMI volumes were reduced by 28% during the pandemic period | ||
| Desai, 2020 | Stroke and TIA admissions | Strokes - 2017 (163); 2018 (161); 2019 (159)/TIA – 2017 (11); 2018 (18); 2019 (16) | Stroke (96); TIA (6) | Number of acute ischemic strokes and TIAs decreased by 40% and 60% respectively, from March 2017−2019 to March 2020 | ||
| Diegoli, 2020 | Stroke admissions | 12.9 cases/100,000 | 8.3 cases/100,000 | When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions in 2020 | No differences in admissions for stroke severity | |
| Gitt, 2020 | ACS admissions | STEMI (49); NSTEMI (95); UA (94) | STEMI (46); NSTEMI (50); UA (48) | During the pandemic, there was a 50% reduction in both unstable angina and NSTEMI | ||
| Hammad, 2020 | STEMI admissions | 108 | 35 | Lower STEMI admissions during the pandemic period. | Post-COVID-19 presentation was severe compared to pre-COVID-19 | |
| Kerleroux, 2020 | Stroke patients receiving mechanical thrombectomy | 844 | 668 | There was a 21% significant decrease in MT case volumes during the pandemic period | ||
| Montaner, 2020 | Stroke admissions | 25% reduction in stroke admissions during the pandemic period. 40% reductions in TIAs attending the emergency department | ||||
| Neves Briard, 2020 | Stroke admissions | 138 | 156 | The first two months of the COVID-19 pandemic were not associated with a decrease in acute stroke evaluations | ||
| Pop, 2020 | Stroke admissions | 167 | 122 | Compared to the same period in 2019, there were 39.6% fewer stroke alerts in 2020 | ||
| Popovic, 2020 | STEMI patients undergoing PCI | 1552 | 83 | |||
| Range, 2020 | STEMI patients undergoing PCI | 1942 | 122 | There was a significant drop (12%) in mean number of STEMI/month in the lockdown group compared with prelockdown (139 vs 122, p < 0.04). | ||
| Reinstadler, 2020 | STEMI patients referred for PCI | 163 | Rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%) | |||
| Sarfo, 2020 | Stroke admissions | 401 | 431 | Stroke admissions were higher during the pandemic period (increase of 7.5%). Recurrent stroke admissions were also higher during the pandemic period | ||
| Teo, 2020 | Stroke admissions | 89 | 73 | Fewer stroke admissions in pandemic period | No differences in stroke severity | |
| Toner, 2020 | ACS undergoing PCI | 102 | 20 | The case volume for the number of ACS patients undergoing PCI was not significantly different in the COVID and non-COVID eras | ||
| Abdelaziz, 2020 | STEMI patients undergoing PCI | 69 | 46 | Fewer STEMI admissions in the pandemic period | Higher cardiac troponin-I levels on admission in STEMI patients during pandemic than pre-COVID era | |
| Agarwal, 2020 | Acute ischemic stroke care | 634 | 120 | Fewer admissions during pandemic compared to pre-pandemic | Pandemic patients presented with a higher median admission NIHSS scores. | |
| Burgos, 2020 | HF admissions | 49 | 36 | 26.5% decrease in number of HF admissions during the pandemic period | ||
| Aldujeli, 2020 | AMI admissions | NSTEMI (62); STEMI (60) | NSTEMI (30); STEMI (47) | Fewer admissions during pandemic compared to pre-pandemic | ||
| Andersson, 2020 | New-onset and worsening HF admissions | New-onset HF (2819); Worsening HF (1419) | New-onset HF (2595); Worsening HF (1364) | In the lockdown period, rates of new-onset HF diagnoses and of hospitalizations for worsening HF were significantly lower in 2020 versus 2019 | ||
| Ball, 2020 | CVDs admissions | Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1–2 weeks before lockdown and fell by 31%–88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures, compared with the previous year. | ||||
| Boeddinghaus, 2020 | ACS admissions | 220 | 178 | Compared to January/February 2020, there was a dramatic reduction of ED presentations after the COVID-19 outbreak on March 1st (31% relative reduction). Comparing March/April 2020 to that of 2019, there was a 38.7% reduction in ED presentations | ||
| Bromage, 2020 | HF admissions | 78 | 26 | Significantly lower admission rate for HF was observed during the study covid-19 pandemic compared to all other included time periods. | Patients admitted during the COVID-19 pandemic had higher rates of NYHA III or IV symptoms and severe peripheral oedema | |
| Bryndza, 2021 | AMI admissions | 1055 | 827 | In comparison to the control period, there was a 21.6% decrease in the total number of AMI cases (a 18.6% decrease in the number of patients with STEMI and a 23.9% decrease in the number of patients with NSTEMI). | ||
| Cammalleri, 2020 | STEMI patients undergoing PCI | 35 | 13 | During March 2020, there was a 63% reduction of patients with STEMI admitted for PCI, when compared with the same period of 2019 | Patients in 2020 had higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline | |
| Candelaresi, 2021 | Stroke admissions | The global number of patients presenting with acute stroke did not significantly differ between the periods | Baseline NIHSS score was significantly more severe during the lockdown compared to the same period of 2019 and tended to be more severe compared to the immediate prelockdown phase | |||
| Chew, 2021 | STEMI patients undergoing PCI | 208 | 95 | Fewer admissions during pandemic compared to pre-pandemic | ||
| Choudhary, 2020 | Cardiovascular emergencies (ACS, acute decompensated HF and high degree AV block) | 1488 | 830 | 289 | Fewer emergency cardiovascular admissions during the lockdown period than the pre-lockdown and pre-COVID periods. | Risk factors associated with poorer prognosis in ACS were higher in patients during the lockdown and pre-lockdown period compared to pre-COVID period. |
| Çinier, 2020 | STEMI patients undergoing PCI | 174 | 90 | Significant reduction in STEMI cases during COVID-19 pandemic compared to previous year | ||
| Colivicchi, 2020 | Acute HF admissions | 6060 | 2711 | The number of patients with acute HF decreased by 49% during the pandemic period | Risk factors associated with poorer prognosis were higher in patients during the pandemic compared to the pre-COVID period | |
| Cummings, 2020 | Tele stroke consulations | 5239 | 613 | Fewer stroke patients were seen during the pandemic. The median number of weekly consults dropped from 112 to 77 during the pandemic. Black patients were less likely to present with strokes during the pandemic | ||
| Del Pinto, 2020 | CVDs admissions | Less cardiovascular hospitalizations occurred in 2020 than in 2019 | ||||
| Enache, 2020 | CVDs admissions | 419 | 346 | Compared to March 2019, the total cardiovascular admissions were lower by 17%. Similarly, compared to March 2019, cardiovascular emergency admissions were down by 21%. | ||
| Erol, 2020 | AMI admissions | 1872 | 991 | There was a 47.1% decrease in acute MI admissions during the pandemic. This reduction in admission was more prominent in patients with NSTEMI compared with STEMI | ||
| Frisullo, 2020 | Ischemic stroke admissions | 41 | 52 | No significant difference observed between 2019 and 2020 in number of admissions | ||
| Giannouchos, 2021 | ED visits for medical conditions (included hypertension and diabetes) | Hypertension (461); diabetes (300) | Hypertension (251); diabetes (209) | Decrease in ED visits for both hypertension and diabetes | ||
| Hoyer, 2020 | Ischemic stroke admissions | A significant decrease in the number of admissions for transient ischemic attack was observed in 3 of 4 centers during the pandemic | ||||
| Hsiao, 2020 | Stroke consultations | Compared with the 10 weeks prior, stroke consultations declined by 39% in the 5 weeks after announcement of COVID-19 mitigation measures. Results compared with the prior year and time trend analyses were consistent | ||||
| JF Huang, 2020 | Tele stroke activations | 142 | 71 | There was a 50% reduction in stroke volume activations during the post-pandemic declaration period | ||
| Ikenberg, 2020 | Stroke referrals | 171 | 70 | The absolute daily number of Code Stroke referrals and the portion of patients with stroke mimics remained stable. The portion of female stroke patients decreased (55% to 33%; p = 0.03) during the lockdown. | Stroke severity as measured by the NIHSS increased during the lockdown. | |
| Jasne, 2020 | Stroke code activations | 786 | 756 | There was a significant decline in weekly stroke code volumes at the 3 hospitals from January to April, 2020. 30% decrease in total stroke codes during the pandemic weeks in 2020 versus 2019 | There was no difference in stroke severity | |
| John, 2020 | Stroke admissions | 148 | 210 | There was a 41.9% increase in stroke admissions in 2020. The difference in 2020 was driven by significant increases in ischemic stroke, intracerebral hemorrhage and stroke mimics. | Ischemic stroke: Severity of stroke presentation was higher in 2020 as recorded by the NIHSS. | |
| Kobo, 2020 | STEMI patients undergoing PCI | 136 | 107 | There was a 22% decrease in STEMI admissions | Patients admitted in 2020 had higher admission and peak troponin levels | |
| Kuitunen, 2020 | ED visits and inpatient admissions for medical conditions (included AMI, strokes and other heart disease) | Stroke (553); AMI (650); other heart disease (1837) | Stroke (558); AMI (645); other heart disease (1513) | The visit rate and inpatient admissions due to AMI and strokes remained stable throughout the study period. | ||
| Lauridsen, 2020 | AMI admissions | AMI (11,769); AMI-CS (342) | AMI (2132); AMI-CS (60) | The total number of MI patients decreased by 15% during lockdown comparing the average number of MI admissions in 2015–2019 with the number of MIs in 2020 | The incidence proportions of AMI-related cardiogenic shock were similar during lockdown comparing 2015–2019 and 2020 | |
| Little, 2020 | STEMI admissions | 440 | 348 | There was a 21% reduction in STEMI admissions in 2020 vs in 2019 | ||
| Nagamine, 2020 | Ischemic stroke admissions | 68 | 48 | There was reduction in stroke admissions in 2020 compared to 2019 | ||
| Mitra, 2020 | Acute stroke and AMI admissions | 57 | 52 | There was a 9.6% reduction in stroke and AMI admissions in 2020 compared to 2020 | ||
| Nguyen-Huynh, 2020 | Acute stroke presentations | 8337 | 783 | Stroke volumes decreased significantly post lockdown compared with pre-lockdown | Post-lockdown patients had higher NIHSS scores, lower comorbidity score, and arrived more often by ambulance. Post-lockdown patients also had large vessel occlusions. | |
| Oseran, 2020 | Cardiovascular admissions | During the pandemic period, there was a decrease in admission rates for all conditions including cardiovascular conditions | ||||
| Paliwal, 2020 | Stroke admissions | 206 | 144 | Decline in stroke activations | In terms of stroke severity, the median NIHSS on arrival was similar | |
| Papafaklis, 2020 | ACS admissions | 1077 | 771 | ACS admissions in the COVID-19 period were reduced by 28.4% compared to 2019 | During the COVID-19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment | |
| Piuhola, 2020 | STEMI admissions | During 2017–2019, there were no marked differences in STEMI incidence between January, February and March. During 2020, there was an average drop of 32% in STEMI incidence in March. | ||||
| Rashid Hons, 2020 | AMI admissions with OHCA | 731 | 524 | AMI hospitalizations during COVID-19 period were reduced by >50% | ||
| Richter, 2021 | Stroke admissions | Decline in hospitalizations during the pandemic compared to the pre-pandemic period | ||||
| Rodríguez-Leor, 2020 | STEMI admissions | 1305 | 1009 | Suspected STEMI patients treated in STEMI networks decreased by 27.6% with a reduction in confirmed STEMI cases by 22.7% during the pandemic | ||
| Ruparelia, 2020 | ACS admissions | 376 | 280 | There was a significant reduction in the entire spectrum of ACSs following the beginning of the COVID-19 pandemic | ||
| Schirmer, 2020 | Stroke admissions | 320 | 163 | In the COVID period in 2020, there was a drop in the absolute number of cases per calendar week | There was no difference in the severity of the presentation between groups | |
| Seiffert, 2020 | Admissions for AMI, acute limb ischemia, aortic rupture, stroke or TIA | 78.6/100,000 | 70.6/100,000 | Monthly admission rates declined from pre-COVID to COVID periods. The lowest admission rate was observed in April 2020 | ||
| Sharma, 2020 | Stroke and TIA admissions | There was a decline in stroke/TIA admissions and ED stroke alerts during 30 December 2019 to 19 April 2020. The greatest decline in hospital admissions was observed between 23 March and 19 April 2020 | Baseline NIHSS score was higher in the pandemic period | |||
| Siegler, 2020 | Stroke admissions | 275 | 53 | There was a mean fall of 38% in new stroke diagnoses | No difference with respect to severity of stroke | |
| Tejada Meza, 2020 | Stroke admissions | 173/week | 124/week | There was a decrease in the weekly mean admitted patients during the pandemic | ||
| Uchino, 2020 | Stroke presentations | 10 alerts/day | 8 alerts/day | There was a significant decrease in acute stroke presentations by 30% across emergency departments during the COVID-19 period | Stroke severity measured by NIHSS was unchanged. | |
| Vensentini, 2020 | CVDs admissions | Average (595) | Average (348) | The average number of CVD admissions decreased by 46.8% during the COVID-19 period. Reductions in cardiovascular surgery 72.3%, electrophysiological interventions 67.8%, NSTEMI 52.6%, angioplasties 47.6%, arrhythmias 48.7%, heart failure 46%, atrial fibrillation 35.7%, STEMI 34.7%, non cardiac chest pain 31.8% and others 51.6% during the COVID-19 period. Hypertensive crisis increased by 89% | ||
| Wadhera, 2021 | CVD deaths | 199,311 | 197,731 | Deaths caused by ischemic heart disease and hypertensive disease increased nationally after the onset of the pandemic in 2020, compared with changes over the same period in 2019, but not for heart failure, cerebrovascular disease, or other diseases of the circulatory system. | ||
| J Wang, 2020 | Acute ischemic stroke admissions | 320 | 255 | There was a 22.1% and 39.5% decline in admission for acute ischemic stroke in April and May 2020, respectively. | Stroke severity at presentation measured by NIHSS was unchanged. | |
| Yang, 2020 | Acute stroke patients undergoing endovascular thrombectomy | 34 | 21 | Decline in acute stroke patients undergoing endovascular thrombectomy during the pandemic era | Stroke severity at presentation measured by NIHSS was unchanged. | |
| Zhao, 2020 | Stroke care | Hospital admissions related to stroke dropped by 40% | ||||
| Cox, 2020 | Acute HF admissions | 62% decrease in HF admissions during the pandemic period relative to last year | Severity at admission was unchanged |