PT  - JOURNAL ARTICLE
AU  - Raul G Nogueira
AU  - Katherine Etter
AU  - Thanh N Nguyen
AU  - Shelly Ikeme
AU  - Charlene Wong
AU  - Michael Frankel
AU  - Diogo C Haussen
AU  - Carlos Del Rio
AU  - Michael McDaniel
AU  - Rajesh Sachdeva
AU  - Chandan M Devireddy
AU  - Alhamza R Al-Bayati
AU  - Mahmoud H Mohammaden
AU  - Mohamed F Doheim
AU  - Agostinho C Pinheiro
AU  - Bernardo Liberato
AU  - Dinesh V Jillella
AU  - Nirav R Bhatt
AU  - Rahul Khanna
TI  - 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
AID  - 10.1136/bmjmed-2022-000207
DP  - 2023 May 01
TA  - BMJ Medicine
PG  - e000207
VI  - 2
IP  - 1
4099  - http://bmjmedicine.bmj.com/content/2/1/e000207.short
4100  - http://bmjmedicine.bmj.com/content/2/1/e000207.full
SO  - bmjmed2023 May 01; 2
AB  - 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.Data are available upon reasonable request.