“Missing” acute coronary syndrome hospitalizations during the <scp>COVID</scp>‐19 era in Greece: Medical care avoidance combined with a true reduction in incidence?

Clinical Cardiology - Tập 43 Số 10 - Trang 1142-1149 - 2020
Michail I. Papafaklis1, Christos S. Katsouras1, Grigorios Tsigkas2, Konstantinos Toutouzas3, Periklis Davlouros2, George Hahalis2, Maria Kousta4, Ioannis Styliadis5, Konstantinos Triantafillou6, Loukas K. Pappas7, Fotini Tsiourantani8, Efthymia Varytimiadi9, Zacharias‐Alexandros Anyfantakis10, Nikolaos Iakovis10, Paraskevi Grammata11, Haralambos Karvounis12, Antonios Ziakas12, George Sianos12, Dimitrios Tziakas13, Eugenia Pappa14, Anna Dagre15, Sotirios Patsilinakos16, Athanasios Trikas17, Thomais Lamprou18, Ioannis Mamarelis19, Georgios Katsimagklis20, Dimitri Karmpaliotis21, Mario Marzilli1, Lampros K. Michalis1
12nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
2Department of Cardiology, Patras University Hospital, Patras, Greece
31st Department of Cardiology, "Hippokration" University Hospital, Athens, Greece
4Cardiology Department, General Hospital "G. Gennimatas", Athens, Greece
52nd Department of Cardiology, "Papageorgiou" General Hospital, Thessaloniki, Greece
61st Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
72nd Department of Cardiology, Evaggelismos General Hospital, Athens, Greece
82nd Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
9Department of Cardiology, ‘Attikon’ University Hospital, Athens, Greece
10Department of Cardiology, University Hospital of Larissa, Larissa, Greece
11Department of Cardiology, "Sismanogleio" General Hospital, Athens, Greece
12Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
13Department of Cardiology, University Hospital of Alexandroupolis, Thrace, Greece
14Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
15Department of Cardiology, "Thriasion" General Hospital of Elefsina, Attiki, Greece
16Department of Cardiology, "Konstandopoulio" General Hospital, Athens, Greece
17Department of Cardiology, "Elpis" General Hospital, Athens, Greece
182nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", Piraeus, Greece
19Department of Cardiology, 401 Army General Hospital, Athens, Greece
20Department of Cardiology, Athens Naval Hospital, Athens, Greece
21Department of Cardiology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA

Tóm tắt

AbstractBackgroundReports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known.HypothesisACS admissions were reduced in a country spared by COVID‐19.MethodsWe conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality.ResultsACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P < .001) and for each ACS type (ST‐segment elevation myocardial infarction [STEMI]: IRR: 0.76, P = .001; non‐STEMI: IRR: 0.74, P < .001; and unstable angina [UA]: IRR: 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID‐19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non‐STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID‐19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P < .001).ConclusionsWe observed a reduction in ACS hospitalizations during the COVID‐19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self‐isolation/quarantining may have also played a role.

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Clinical Cardiology

Tập 43 Số 10

1142-1149

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