Greater decline of acute stroke admissions compared with acute coronary syndromes during COVID-19 outbreak in Greece: Cerebro/Cardiovascular implications amidst a second wave surge.

Katsouras, Christos; Karapanayiotides, Theodoros; Papafaklis, Michail; Giannopoulos, Sotirios; Ziakas, Antonios; Sianos, George; Papagiannopoulou, Georgia; Koutroulou, Ioanna; Varytimiadi, Eythimia; Kosmidou, Maria; Naka, Katerina; Michalis, Lampros K; Tsivgoulis, Georgios

BACKGROUND A remarkable decline in admissions for acute stroke and acute coronary syndrome (ACS) has been reported in countries severely hit by the COVID-19 pandemic. However, limited data are available from countries with less COVID-19 burden focusing on concurrent stroke and ACS hospitalisation rates from the same population. METHODS The study was conducted in three geographically and demographically representative COVID-19 referral university hospitals in Greece. We recorded the rate of stroke and ACS hospital admissions during a 6-week period of the COVID-19 outbreak in 2020 and compared them with the rates of the corresponding period in 2019. RESULTS We found a greater relative reduction of stroke admissions (51% [35 vs 71]; incidence rate ratio [IRR]: 0.49, p=0.001) compared with ACS admissions (27% [123 vs 168]; IRR: 0.73, p=0.009) during the COVID-19 outbreak (p=0.097). Fewer older (>65 years) patients (Stroke: 34.3 vs 45.1%, OR: 0.64, p=0.291; ACS: 39.8 vs 54.2%, OR: 0.56, p=0.016) were admitted during the COVID-19 compared with the control period. CONCLUSIONS Hospitalisation rates both for stroke and ACS were reduced during the COVID-19 outbreak in a country with strict social distancing measures, low COVID-19 incidence and low population mortality. Lack of triggers for stroke and ACS during social distancing/quarantining may explain these observations. However, medical care avoidance attitudes among cerbro/cardiovascular patients should be dissipated amidst the rising second COVID-19 wave.