With the rapid onset of COVID hospitalizations in spring 2020, the number of hospitalizations for other conditions was anticipated to decline due to staffing and space constraints, reallocation, and patient fears, among other factors. And decline it did, as reported by Duke Professor of Medicine Frank Wharam and team in a recent research letter published in JAMA Health Forum. The researchers analyzed administrative and claims data for cardiovascular health events from Harvard Pilgrim Health Care, which provides care to about 1 million members in Massachusetts, New Hampshire, Connecticut, and Maine. In April 2020, five types of cardiovascular events declined substantially compared to pre-COVID levels: stroke hospitalization, congestive heart failure episodes, myocardial infarction hospitalizations, transient ischemic attack episodes. and angina episodes. The greatest absolute declines were observed for congestive heart failure and angina episodes.
Rather surprisingly, after these large early reductions in serious cardiovascular events, rates did not ultimately exceed expected levels for any of the cardiovascular outcomes up to 21 months after the pandemic onset. In fact, by the end of 2021, angina, stroke and congestive heart failure rates remained below expected levels, while myocardial infarction and transient ischemic attack rates returned to expected levels.
“The findings add to an increasing understanding of the complex effects of the COVID pandemic, the resulting public health measures, and responses by patients,” said Wharam. “We were surprised to see sustained reductions in adverse cardiovascular events in the 21 months after the pandemic began.”
Individuals with cardiovascular conditions were at higher risk for COVID-19 hospitalizations and deaths and therefore, some of the observed decline may be masked by the increases in COVID admissions and deaths for these particular patients.
In 2023, the American Heart Association reported increases in cardiovascular-related deaths following the initial months of the pandemic. In other reports, infection with COVID-19 has been associated with higher risks of myocardial infarction and stroke. Foregoing immediate care may have contributed to the increase in deaths and the avoidance of preventive care may likely contribute to future increases of cardiovascular-related morbidity and mortality trends. Likewise, some groups have reported declines in cancer preventive screenings during the pandemic, though data are conflicting across reports.
“It’s tempting to classify our findings as either reassuring or concerning,” Wharam stated, “and to try to attribute simple causes. But my sense is that underlying causes are multiple and complex, and likely even differ by type of cardiovascular event. Further research is needed to understand reasons for sustained reductions, patterns in other regions of the country, and longer-term implications of these reductions”
Citations:
Wharam JF, LeCates RF, Thomas A, Zhang F, Argetsinger S, Garaedian LF, Galbraith AA. Trends in High-Acuity Cardiovascular Events During the COVID-19 Pandemic. JAMA Health Forum 2024; 5(1): e234571. [link]
American Heart Association. COVID toll realized: CVD deaths take big jump, especially among certain populations. January 25, 2023. [link]