Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic

Abstract

Background: Although patients with cardiovascular disease face excess risks of severe illness with coronavirus disease-2019 (COVID-19), there may be indirect consequences of the pandemic on this high-risk patient segment.

Objectives: This study sought to examine longitudinal trends in hospitalizations for acute cardiovascular conditions across a tertiary care health system.

Methods: Acute cardiovascular hospitalizations were tracked between January 1, 2019, and March 31, 2020. Daily hospitalization rates were estimated using negative binomial models. Temporal trends in hospitalization rates were compared across the first 3 months of 2020, with the first 3 months of 2019 as a reference.

Results: From January 1, 2019, to March 31, 2020, 6,083 patients experienced 7,187 hospitalizations for primary acute cardiovascular reasons. There were 43.4% (95% confidence interval [CI]: 27.4% to 56.0%) fewer estimated daily hospitalizations in March 2020 compared with March 2019 (p < 0.001). The daily rate of hospitalizations did not change throughout 2019 (-0.01% per day [95% CI: -0.04% to +0.02%]; p = 0.50), January 2020 (-0.5% per day [95% CI: -1.6% to +0.5%]; p = 0.31), or February 2020 (+0.7% per day [95% CI: -0.6% to +2.0%]; p = 0.27). There was significant daily decline in hospitalizations in March 2020 (-5.9% per day [95% CI: -7.6% to -4.3%]; p < 0.001). Length of stay was shorter (4.8 days [25th to 75th percentiles: 2.4 to 8.3 days] vs. 6.0 days [25th to 75th percentiles: 3.1 to 9.6 days]; p = 0.003) and in-hospital mortality was not significantly different (6.2% vs. 4.4%; p = 0.30) in March 2020 compared with March 2019.

Conclusions: During the first phase of the COVID-19 pandemic, there was a marked decline in acute cardiovascular hospitalizations, and patients who were admitted had shorter lengths of stay. These data substantiate concerns that acute care of cardiovascular conditions may be delayed, deferred, or abbreviated during the COVID-19 pandemic.

Keywords: COVID-19; cardiovascular; coronavirus; hospitalizations.

Graphical abstract

Figure 1

Geographic Distribution of Patients Admitted to a Large Tertiary Care Health System Geographic distribution of the primary residences of 6,083 patients admitted for acute cardiovascular reasons across the Mass General Brigham health care system from January 1, 2019, to March 31, 2020. Tableau software (Seattle, Washington) was used for geomapping by the zip codes of patients’ primary residences.

Figure 2

Changes in the Daily Rate of Cardiovascular Hospitalization During the COVID-19 Pandemic Changes in estimated daily hospitalization rates for acute cardiovascular conditions from January 1, 2020, through March 31, 2020. The blue line delineates daily changes in hospitalization rate for acute CV conditions for the corresponding time period in calendar year 2019 as a reference. The dashed lines represent 95% confidence intervals. COVID-19 = coronavirus disease-2019; CV = cardiovascular.

Central Illustration

Changes in the Rate of Cause-Specific Cardiovascular Hospitalization During the COVID-19 Pandemic Change in total and cause-specific acute cardiovascular hospitalizations by week from January 1, 2020, to March 31, 2020. The dashed gray line represents the total acute CV hospitalization for the corresponding time period in calendar year 2019 for reference. The red line represents the cumulative number of confirmed COVID-19 cases in Massachusetts. The red arrows demarcate key dates in the COVID-19 pandemic in Massachusetts. ∗Indicates a partial week. CV = cardiovascular; COVID-19 = coronavirus disease-2019.

Figure 3

Hospital LOS Before and During the COVID-19 Pandemic Total hospital LOS of cardiovascular hospitalizations in March 2020 and before March 2020 and separately for the first 3 months of 2019 and 2020. Each square represents the median LOS, and the bars reflect the 25th and 75th percentiles. LOS = length of stay; other abbreviations as in Figure 2.

Figure 4

In-Hospital Mortality Before and During the COVID-19 Pandemic All-cause mortality observed during cardiovascular hospitalizations in March 2020 and before March 2020 and separately for the first 3 months of 2019 and 2020. The error bars reflect standard errors. Abbreviations as in Figure 2.