학술논문
Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis.
Document Type
Academic Journal
Author
Nogueira RG; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.; Etter K; Global Provider and Payer Value Demonstration, Health Economics and Market Access, Johnson & Johnson, Raynham, MA, USA.; Nguyen TN; Department of Neurology, Boston University School of Medicine, Boston, MA, USA.; Ikeme S; Franchise Health Economics and Market Access, Johnson & Johnson, New Brunswick, NJ, USA.; Wong C; Global Provider and Payer Value Demonstration, Health Economics and Market Access, Johnson & Johnson, Raynham, MA, USA.; Frankel M; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.; Haussen DC; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.; Del Rio C; Department of Medicine, Grady Memorial Hospital, Atlanta, GA, USA.; McDaniel M; Department of Cardiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA.; Sachdeva R; Department of Cardiology, Veterans Affairs Medical Center, Atlanta, GA, USA.; Devireddy CM; Department of Cardiology, Emory University Hospital Midtown, Emory University School of Medicine, Atlanta, GA, USA.; Al-Bayati AR; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.; Mohammaden MH; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.; Doheim MF; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.; Pinheiro AC; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.; Liberato B; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.; Jillella DV; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.; Bhatt NR; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.; Khanna R; Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, NJ, USA.
Source
Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 9918487584306676 Publication Model: eCollection Cited Medium: Internet ISSN: 2754-0413 (Electronic) Linking ISSN: 27540413 NLM ISO Abbreviation: BMJ Med Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Objective: To measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction.
Design: A retrospective analysis.
Setting: 746 qualifying hospitals in the USA from the Premier Healthcare Database.
Participants: Patients aged 18 years and older who were admitted to hospital with a primary diagnosis of acute ischemic stroke or acute myocardial infarction between 1 March 2019 and 28 February 2021.
Main Outcome Measures: Relative changes in volumes were assessed for acute ischemic stroke and acute myocardial infarction hospital admissions as well as intravenous thrombolysis, mechanical thrombectomy, and percutaneous coronary intervention (overall and for acute myocardial infarction only) across the first year of the pandemic versus the prior year. Mortality in hospital and length of stay in hospital were also compared across the first year of the pandemic versus the corresponding period the year prior. These metrics were explored across the different pandemic waves.
Results: Among 746 qualifying hospitals, admissions to hospital were significantly reduced after the covid-19 pandemic compared with before the pandemic for acute ischemic stroke (-13.59% (95% confidence interval-13.77% to -13.41%) and acute myocardial infarction (-17.20% (-17.39% to -17.01%)), as well as intravenous thrombolysis (-9.47% (-9.99% to -9.02%)), any percutaneous coronary intervention (-17.89% (-18.06% to -17.71%)), and percutaneous coronary intervention for acute myocardial infarction (-14.36% (-14.59% to -14.12%)). During the first year of the pandemic versus the previous year, the odds of mortality in hospital for acute ischemic stroke were 9.00% higher (3.51% v 3.16%; ratio of the means 1.09 (95% confidence interval (1.03 to 1.15); P=0.0013) and for acute myocardial infarction were 18.00% higher (4.81% v 4.29%; ratio of the means 1.18 (1.13 to 1.23); P<0.0001).
Conclusions: We observed substantial decreases in admissions to hospital with acute ischemic stroke and acute myocardial infarction, but an increase in mortality in hospital throughout the first year of the pandemic. Public health interventions are needed to prevent these reductions in future pandemics.
Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW) trial. Funding for this project is provided by Cerenovus. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, and Viseon. TNN reports research support from Medtronic, Society of Vascular and Interventional Neurology (SVIN) and Data Safety Monitoring Board participation on the TESLA, ENDOLOW, SELECT-2, PROST, CREST-2, and WE-TRUST trials. KE, SI, CW, and RK are employees of Johnson & Johnson and provided analytical support for this manuscript. DCH reports consulting fees from Stryker, Cerenovus and Vesalio and stock options in VizAI. CMD reports consulting fees from Medtronic, ReCor Medical, Vascular Dynamics and Proctor fees from Edwards Lifesciences. ARAB reports consulting fees from Stryker.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Design: A retrospective analysis.
Setting: 746 qualifying hospitals in the USA from the Premier Healthcare Database.
Participants: Patients aged 18 years and older who were admitted to hospital with a primary diagnosis of acute ischemic stroke or acute myocardial infarction between 1 March 2019 and 28 February 2021.
Main Outcome Measures: Relative changes in volumes were assessed for acute ischemic stroke and acute myocardial infarction hospital admissions as well as intravenous thrombolysis, mechanical thrombectomy, and percutaneous coronary intervention (overall and for acute myocardial infarction only) across the first year of the pandemic versus the prior year. Mortality in hospital and length of stay in hospital were also compared across the first year of the pandemic versus the corresponding period the year prior. These metrics were explored across the different pandemic waves.
Results: Among 746 qualifying hospitals, admissions to hospital were significantly reduced after the covid-19 pandemic compared with before the pandemic for acute ischemic stroke (-13.59% (95% confidence interval-13.77% to -13.41%) and acute myocardial infarction (-17.20% (-17.39% to -17.01%)), as well as intravenous thrombolysis (-9.47% (-9.99% to -9.02%)), any percutaneous coronary intervention (-17.89% (-18.06% to -17.71%)), and percutaneous coronary intervention for acute myocardial infarction (-14.36% (-14.59% to -14.12%)). During the first year of the pandemic versus the previous year, the odds of mortality in hospital for acute ischemic stroke were 9.00% higher (3.51% v 3.16%; ratio of the means 1.09 (95% confidence interval (1.03 to 1.15); P=0.0013) and for acute myocardial infarction were 18.00% higher (4.81% v 4.29%; ratio of the means 1.18 (1.13 to 1.23); P<0.0001).
Conclusions: We observed substantial decreases in admissions to hospital with acute ischemic stroke and acute myocardial infarction, but an increase in mortality in hospital throughout the first year of the pandemic. Public health interventions are needed to prevent these reductions in future pandemics.
Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW) trial. Funding for this project is provided by Cerenovus. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, and Viseon. TNN reports research support from Medtronic, Society of Vascular and Interventional Neurology (SVIN) and Data Safety Monitoring Board participation on the TESLA, ENDOLOW, SELECT-2, PROST, CREST-2, and WE-TRUST trials. KE, SI, CW, and RK are employees of Johnson & Johnson and provided analytical support for this manuscript. DCH reports consulting fees from Stryker, Cerenovus and Vesalio and stock options in VizAI. CMD reports consulting fees from Medtronic, ReCor Medical, Vascular Dynamics and Proctor fees from Edwards Lifesciences. ARAB reports consulting fees from Stryker.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)