Impact of coronavirus disease 2019 (COVID-19) outbreak on acute admissions at the emergency and cardiology departments across Europe

Sokolski, Mateusz; Gajewski, Piotr; Zymlinski, Robert; Biegus, Jan; Berg, Jurrien M Ten; Bor, Wilbert; Braunschweig, Frieder; Caldeira, Daniel; Cuculi, Florim; D'Elia, Emilia; Edes, Istvan Ferenc; Garus, Mateusz; Greenwood, John P; Halfwerk, Frank R; Hindricks, Gerhard; Knuuti, Juhani; Kristensen, Steen Dalby; Landmesser, Ulf; Lund, Lars H; Lyon, Alexander; Mebazaa, Alexandre; Merkely, Béla; Nawrocka-Millward, Sylwia; Pinto, Fausto J; Ruschitzka, Frank; Semedo, Edimir; Senni, Michele; Shamloo, Alireza Sepehri; Sorensen, Jacob; Stengaard, Carsten; Thiele, Holger; Toggweiler, Stefan; Tukiendorf, Andrzej; Verhorst, Patrick M; Wright, David Jay; Zamorano, Pepe; Zuber, Michel; Narula, Jagat; Bax, Jeroen J; Ponikowski, Piotr

PURPOSE: We evaluated whether the severe acute respiratory syndrome coronavirus 2 pandemic was associated with changes in the pattern of acute cardiovascular admissions across European centres. METHODS: We set-up a multi-centre, multi-national, pan-European observational registry in 15 centres from 12 countries. All consecutive acute admissions to emergency departments and cardiology departments throughout a 1-month period during the COVID-19 outbreak were compared with an equivalent 1-month period in 2019. The acute admissions to cardiology departments were classified into 5 major categories: acute coronary syndrome, acute heart failure, arrhythmia, pulmonary embolism and other. RESULTS: Data from 54331 patients were collected and analysed. Nine centres provided data on acute admissions to emergency departments comprising 50384 patients: 20226 in 2020 vs 30158 in 2019 – incidence rate ratio (IRR) with 95% confidence interval (95%CI): 0.66(0.58-0.76). The risk of death at the emergency departments was higher in 2020 vs 2019: odds ratio (OR) with 95%CI: 4.1(3.0-5.8), P<0.0001. All 15 centers provided data on acute cardiology departments admissions: 3007 patients in 2020 vs 4452 in 2019, respectively, IRR(95%CI): 0.68(0.64-0.71). In 2020, there were less admissions with IRR(95%CI): acute coronary syndrome: 0.68(0.63-0.73), acute heart failure: 0.65(0.58-0.74), arrhythmia: 0.66(0.60-0.72), other: 0.68(0.62-0.76); we found a relatively higher percentage of pulmonary embolism admissions in 2020: OR(95%CI): 1.5(1.1-2.1), P=0.02. Among patients with acute coronary syndrome there were fewer admissions with unstable angina: 0.79(0.66-0.94), non-ST segment elevation myocardial infarction: 0.56(0.50-0.64) and ST-segment elevation myocardial infarction: 0.78(0.68-0.89). CONCLUSION: In the European centres during the COVID-19 outbreak, there were fewer acute cardiovascular admissions. Also, fewer patients were admitted to the emergency departments with 4-times higher death risk at the emergency departments.