"Missing" acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence?

Abstract

BACKGROUND:

Reports 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.

HYPOTHESIS:

ACS admissions were reduced in a country spared by COVID-19.

METHODS:

We 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.

RESULTS:

ACS 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).

CONCLUSIONS:

We 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.

• Authors: Michail I Papafaklis, Christos S Katsouras, Grigorios Tsigkas, Konstantinos Toutouzas, Periklis Davlouros, George N Hahalis, Maria S Kousta, Ioannis G Styliadis, Konstantinos Triantafyllou, Loukas Pappas, Fotini Tsiourantani, Efthymia Varytimiadi, Zacharias-Alexandros Anyfantakis, Nikolaos Iakovis, Paraskevi Grammata, Haralambos Karvounis, Antonios Ziakas, George Sianos, Dimitrios Tziakas, Evgenia Pappa, Anna Dagre, Sotirios Patsilinakos, Athanasios Trikas, Thomais Lamprou, Ioannis Mamarelis, Georgios Katsimagklis, Dimitri Karmpaliotis, Katerina Naka, Lampros K Michalis
• Journal: Clinical cardiology (Clin Cardiol) Vol. 43 Issue 10 Pg. 1142-1149 (Oct 2020) ISSN: 1932-8737 [Electronic] United States
• PMID: 32691901 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Topics

• Acute Coronary Syndrome (epidemiology)
• Aged
• COVID-19 (epidemiology)
• Coronary Angiography
• Female
• Greece (epidemiology)
• Hospitalization (statistics & numerical data)
• Humans
• Incidence
• Male
• Middle Aged
• Pandemics
• Retrospective Studies
• SARS-CoV-2