Impact of the COVID-19 Pandemic on Cardiology Emergency Department Visits

In 2020, decreased emergency department (ED) visits and hospitalization rates during the COVID-19 out-break were reported. There is no data about cardiovascular emergencies and mortality for the whole COVID-19 year. This study aimed to compare the rates of cardiology ED visits, hospital admissions, and intrahospital mor-tality between the pre-COVID-19 and COVID-19 years in a single high-volume center. The retrospective observational cross-sectional study analyzed data on the number of ED visits, hospital admissions by different cardiovascular diagnoses, and outcomes. A total of 11744 patients visited the cardiology ED in the pre-COVID-19 year compared with 9145 in the COVID-19 year, indicating an overall decrease of 22.1% (P = 0.02) (IR 78.76 versus 61.33; incidence rate ra-tios (IRR) 1.28, P = 0.00), with an observed decrease of 25.5% in the number of hospitalizations (33.1% versus 31.6%, P = 0.02). A marked decrease in hospitalizations for cardiovascular emergencies was observed for hy-pertensive heart disease (-72.8%, P < 0.0001), acute coronary syndrome (-17.8%, P < 0.0001), myocardial and pericardial diseases and endocarditis (-61.2%, P = 0.00), and valvular heart disease (-70.8%, P < 0.0001). In the COVID-19 year, patients had increased need for mechanical ventilatory support (7% versus 6.3%, P = 0.03) with no overall difference in intrahospital mortality (IR 2.71 versus 2.78, IRR 0.98, 95% CI 0.82-1.16, P = 0.39). Decreased ED visits and hospitalizations not just in outbreaks but through the whole COVID-19 year high-light the risk of continuous delay of needed care for emergency life-threatening cardiovascular diseases. Urgent comprehensive strategies that will address patient-and system-related factors to decrease morbidity and mortal-ity and prevent collateral damage of the pandemic are needed.