Studies Details Decline in Use of Cardiology Services During COVID-19 Outbreak

New information from a pair of studies is detailing the impact of the coronavirus disease 2019 (COVID-19) pandemic has had on patients in need of a cardiologist.

One detailing a dramatic drop in stroke rates at US hospitals and the other detailing a 50% decline at a UK-based hospital in use of all cardiology services—further evidencing the notion fear of COVID-19 has influenced the decision-making of patients suffering adverse cardiovascular events during the outbreak.

"Our findings underscore the indirect effects of this pandemic. Public health officials, hospital systems and healthcare providers must continue to encourage patients with stroke to seek acute care during this crisis,” wrote investigators of the US-based study.

While experiences with COVID-19 have varied across different regions of the world, one of the common themes has been the impact fear and regulations have had on the actions of patients. Published in BMJ Journals-affiliated publications, the aforementioned studies use different approaches when assessing data but add to the evidence base surrounding the topic.

The US-based study was a retrospective look at weekly hospital admission for stroke and transient ischemic attack (TIA) in time periods ranging from December 31, 2018-April 21, 2019 and December 30, 2019-April 19, 2020 in medical centers located in Boston, New York City, Providence, and Seattle. In their analysis, investigators found a decline occurred during the more recent period while also noting the declines seen in the study coincided with stay-at-home recommendations in late March.

In this study, the greatest decline was seen between March 23-April 19. Investigates noted the number of stroke or TIA admissions decline 31% compared to the corresponding weeks in 2019. Additionally, 3 of the 5 centers included the study experienced a 46% decline in emergency department stroke alerts in late March through April 2020 compared to the same period in 2019.Investigators pointed out the median baseline National Institutes of Health Stroke Scale (NIHSS) score during this 4-week period was 10 in 2020 compared to 7 in 2019.

"Acute stroke therapies are time-sensitive, so decreased healthcare access or utilization may lead to more disabling or fatal strokes, or more severe non-neurological complications related to stroke,” wrote study investigators.

In the UK-based study, investigators sought to assess how the pandemic has influenced the use of cardiology services by patients using National Health Service data. To do so, investigators designed their study to examine the performance indicators of a general hospital in Scotland and compare these rates across 4, 1-month time periods.

Results of the study revealed a 53% drop in patients pressuring with chest pain or breathlessness during the first month of lockdown. Additionally, results indicated a 40% decline in patients diagnosed with myocardial infarction during that period. Investigators also pointed out a 46% reduction in cardiac troponin blood tests, an 87% reduction in 12-lead ECGs, a 44% reduction in inpatients ECGs, and a 75% reduction in NT-proBNP blood tests.

In their study, investigators noted their concern for patients who may have neglected to seek medical attention for a cardiovascular event during the lockdown period of COVID-19.

"At the height of the pandemic, it is acceptable to deviate from the standard level of care and agreed guidelines in order to prioritise the delivery of essential services," study investigators wrote. “However, adverse consequences for some patients presenting with worsening of their underlying cardiac conditions have been inevitable. Consequently, cardiology services should be ready to offer them urgent input and early intervention."

These studies, “The impact of the COVID-19 pandemic on cardiology services,” and “Decline in stroke alerts and hospitalisations during the COVID-19 pandemic,” were published in Stroke and Vascular Neurology and Open Heart, respectively.