Older adults and major cardiovascular events requiring emergency department consultation during the 1st wave of the COVID-19 pandemic: results from the EDEN-4 Study.
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Piñera Salmerón Pascual, Jacob Javier, Miró Òscar, Burillo-Putze Guillermo, García-Lamberechts Eric Jorge, Montero Pérez Francisco Javier, Aguiló Sira, Fernández Cesáreo, Alquézar-Arbé Aitor, Murcia Olagüenaga Ana, Díaz Miguez Francisco Javier, Sousa Mar, Ruiz Asensio Pedro, Paderne Díaz Beatriz, Pablos Pizarro Teresa, de Juan Gómez María Ángeles, Perelló Viola Núria, Hernández-Castells Lourdes, Cortés Soler Alejandro, Delgado Sardina Violeta, Sánchez Serrano Jesús Ángel, Ezponda Patxi, Martínez Lorenzo Andrea, Ortega Liarte Juan Vicente, Hernando Fernández Raquel, Ruiz Aranda Asumpta, González Del Castillo Juan, Red SIESTA
Аннотация
METHODS: We analyzed all patients aged $ 65 years who attended 52 Spanish EDs within 1 week of the 1st COVID-19 wave (April 1-7, 2020; COVID period) and within the same week of the previous year (March 30-April 5, 2019; pre-COVID period). Cardiac events (angina pectoris and myocardial infarction with and without ST-segment elevation) and cerebrovascular events (stroke) were recorded for each period, jointly and individually. We estimated changes in MACE incidence rate per 100,000 persons per year and compared patient characteristics and outcomes (30-day allcause mortality rate, intensive care unit [ICU] admission, and ED revisits, adjusted for patient characteristics) across periods.
RESULTS: ED visits dropped by 61.8% during the COVID period (from 25,557 to 9,770). During this period, 297 patients attended the ED for MACE (incidence rate, 131.2), vs 488 during the pre-COVID period (incidence rate, 215.6; incidence reduction, 39.1%, 95% CI, 29.7-47.3). The reduction in ED visits was significantly greater (P < .001) for cardiac events (43.3 vs 99.9; reduction 56.6%, 95% CI, 45.0-65.8) than for cerebrovascular events (88.8 vs 116.7; reduction 23.9%, 95% CI, 8.5-36.6). Patients with MACE presenting during the COVID period had lower comorbidity. These patients had fewer ICU admissions (OR, 0.338; 95% CI, 0.149-0.764) and more ED revisits (OR, 1.764; 95% CI, 1.116-2.790), with no differences in 30-day mortality (HR, 1.474; 95% CI, 0.971-2.239).
CONCLUSIONS: During the 1st wave of the COVID-19 pandemic, the rate of ED visits for MACE decreased among older adults. Patients who presented had fewer comorbidities, fewer ICU admissions, and more ED revisits, with no significant changes in mortality.