Impact of the COVID-19 pandemic on the volumes and outcomes of acute ischemic stroke and myocardial infarction

Introduction: The COVID-19 pandemic has wreaked havoc on the presentation, care and outcomes of patients with acute cerebrovascular and cardiovascular conditions We sought to measure the national impact of COVID-19 on the care for acute ischemic stroke (AIS) and acute myocardial infarction (AMI) Methods: In this retrospective, observational study, we used the Premier Healthcare Database to evaluate the changes in the volume of care and hospital outcomes for AIS and AMI in relation to the pandemic The pandemic months were defined from March 1, 2020- April 30, 2020 and compared to the same period in the year prior Outcome measures were volumes of hospitalization and reperfusion treatment for AIS and AMI (including intravenous thrombolysis [IVT] and/or mechanical thrombectomy [MT] for AIS and percutaneous coronary interventions [PCI] for AMI) as well as inhospital mortality, hospital length of stay (LOS) and hospitalization costs were compared across a 2- month period at the height of the pandemic versus the corresponding period in the prior year Results: There were 95,453 AIS patients across 145 hospitals and 19,744 AMI patients across 126 hospitals There was a significant nation-wide decline in the absolute number of hospitalizations for AIS (-38 94%;95%CI,-34 75% to -40 71%) and AMI (-38 90%;95%CI,-37 03% to -40 81%) as well as IVT (-30 32%;95%CI,-27 02% to -33 83%), MT (-23 54%;95%CI,-19 84% to -27 70%), and PCI (-35 05%;95%CI,-33 04% to -37 12%) during the first two months of the pandemic This occurred across low-, mid-, and high-volume centers and in all geographic regions Higher in-hospital mortality was observed in AIS patients (5 7% vs 4 2%, p=0 0037;OR 1 41,95%CI 1 1-1 8) but not AMI patients A shift towards an increase in the proportion of admitted AIS and AMI patients receiving reperfusion therapies suggests a greater clinical severity among patients that were hospitalized for these conditions during the pandemic A shorter length of stay (AIS: -17%, AMI: -20%), and decreased hospitalization costs (AIS: -12%, AMI: -19%) were observed Conclusions: Our findings shed light on the combined health outcomes and economic impact the COVID-19 pandemic has had on acute stroke and cardiac emergency care