Impact of a Prolonged COVID-19 Lockdown on Patterns of Admission, Mortality and Performance Indicators in a Cardiovascular Intensive Care Unit

Szarfer, Jorge Luis; Puente, Luciana; Bono, Leandro; Estrella, María Laura; Doppler, Eugenia; Napoli Llobera, Mariano; Arce, María Patricia; Borri, Karina Alejandra; Fiandesio, Mariana Elisa; Ferraris, Marta Josefina; Gagliardi, Juan

BACKGROUND: The effects of an early and prolonged lockdown during the COVID-19 pandemic on cardiovascular intensive care units is not well established. This study analyses patterns of admission, mortality and performance Indicators in a cardiovascular intensive care unit before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the Cardiac Intensive Care Unit at a high-volume reference hospital in Buenos Aires, Argentina comparing hospitalization rates, primary causes of admission, inpatient utilisation indicators, pharmacy supplies expenditures, and in-hospital mortality between March 5 and July 31, 2020 with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)] were females. Overall hospitalisations dropped 53.2% (95%CI: 45.3, 61.0%) from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for noncardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P<0.001). In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020. Pharmacy supplies expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P<0.02). Overall mortality increased from 7% (n=41) to 13.9% (n=19) (P=0.008) at the expense of noncardiac related admissions (3.6% to 19.4%, P=0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first five months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.