Wednesday, October 4

A study investigates the trends in hospitalization rates for cardiovascular diseases during the COVID-19 pandemic.

A Scientific Reports article has examined the differences in CVD hospital diagnoses in the Netherlands compared to the pre-pandemic period during the coronavirus disease 19 (COVID-19).

The investigation found that while several CVD cases decreased, pulmonary embolism (PE) saw a significant rise.

What is the background?

The COVID-19 pandemic caused an increase in excess mortality, which is the death rate that exceeds expected levels. In the Netherlands, there were approximately 30,000 excess deaths between 2020 and 2021, with a total of 341,508 deaths. All excess fatalities were initially caused by COVIDEO, but by late 2022, only 70% of excess died due to the virus.

The impact of COVID-19 has been significant, causing hospital and non-hospital patients to experience higher rates of venous thromboembolism (VTE) and other cardiovascular diseases, while the indirect effect has resulted in healthcare delays and lifestyle changes. Therefore, it is crucial to study the distribution of illnesses related to COID19.

This will help identify what may be new, undiscovered issues, and prepare for the impending disease burden. Although some studies have found a decrease in diagnoses of certain non-COVID-19 diseases such as cerebrovascular events, there is still limited research on how the pandemic affected cardiovascular diseases in clinical settings.

What is the study’s subject matter?

The present study used household income, personal details, mortality rates and hospital diagnosis data from the entire Dutch population (with additional information provided below).

The study primarily focused on diagnosing cardiovascular diseases while in the hospital, using a list of different types of cardiovascular disease recognized by the international classification of diseases (tenth revision, ICD-10 codes). It also sought to establish hospitalization trends for 2020, with specialized attention given to COVID-19.

The data was based on weekly diagnosis rates for cardiovascular diseases, with the projected 2015-2019 data modeling in 2020 if the pandemic had not affected the numbers. Poisson regression models were used to incorporate demographic factors such as age, sex, income, and immigration background.

We used Poisson regression, based on patient profiles and medical history, to calculate IRRs (i.e., 2020 vs. 2019), with a comorbidity index that adjusted for not only heart disease but also other health conditions, and then used R software to facilitate data analysis using multiple specialized packages; finally, we conducted sensitivity analyses, which analyzed all relevant data sets except for imputed diagnoses by primary hospital physicians.

The findings of the study were published in academic journals.

The study conducted today examined the personal traits of individuals during the first phase of the COVID-19 pandemic in the Netherlands in 2020 and compared this data with 2019 statistics. In 2020, the study included 17,376,087 participants, with an average age of 42.3 years, 50.3% being female. Most participants were of Dutch origin (75.7%), and 9.7% had a comorbidity index of 1 or higher.

Between 2015 and 2020, hospital records indicated that VTE incidence rates, including PE and Deep Vein Thrombosis (DVT), were volatile. There was a significant increase in VTES rates during the first COVID-19 outbreak in 2020.

Initially, the rates decreased to pre-pandemic levels, but during the second wave of the pandemie, there was a further increase in PE hospital diagnoses. This was mostly due to an increase that occurred overnight; however, DVT rates in 2020 were similar to those of previous years.

From the first wave of the pandemic, ischemic stroke cases decreased while stabilizing, and by 2020, myocardial infarction cases dropped sharply during the initial wave, though these rates rebounded after the second wave.

The first COVID-19 wave resulted in a decrease in the incidence of transient ischemic attacks (TIA) and other arterial thromboembolic events, which persisted for the remainder of the year.

Between 2015 and 2020, there were weekly incidence rates for atrial fibrillation, heart failure, and other related conditions. The first wave of the pandemic saw a decrease in incidence for various conditions when compared to 2019. However, these rates returned to normalcy by the second wave.

When comparing expected versus actual weekly incidence rates for different cardiovascular diseases in 2020, the patterns were largely similar to those of 2015-2019. While VTE’s incidence rate decreased by 21% during the first wave of the pandemic and by 20% during its second wave, VITE rates were similar enough to be seen in 2019. However, this rate for PE admissions dropped by one-tenth of that from the previous year. This rate was on par with the 2019 rate.

On the other hand, the preliminary report indicated a higher VTE prevalence in 2020, primarily caused by PE, than in 2019. In terms of DVT as presenting diagnosis, it decreased by 36% from previous analysis. However, when only considering uncomplicated diagnoses, results were similar.

What are the conclusions?

In brief, the findings of our study indicate that hospital diagnoses for VTE, primarily PE, increased during both waves of the pandemic in comparison to 2019, but those of other conditions like ischemic stroke, myocardial infarction, and heart failure decreased during the first wave.

The occurrence of these trends may be due to patients’ reluctance to seek care during the pandemic, which results in reduced consultations. Research indicates that 20% of Dutch participants avoided medical care even when symptoms were severe during its first phase.

The lack of resources and potential infection risk that physicians face when referring patients to emergency rooms may also be an issue. The pandemic’s high incidence of VTE incidents, primarily due to PE, has potential long-term consequences, as many PE survivors may develop post-pulmonary embolism syndrome.

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