US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America.
The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America.
Am J Emerg Med. 2021 Sep;47:42-51. doi: 10.1016/j.ajem.2021.03.004. Epub 2021 Mar 9.
We examine how emergency department (ED) visits for serious cardiovascular conditions evolved in the coronavirus (COVID-19) pandemic over January-October 2020, compared to 2019, in a large sample of U.S. EDs.
We compared 2020 ED visits before and during the COVID-19 pandemic, relative to 2019 visits in 108 EDs in 18 states in 115,716 adult ED visits with diagnoses for five serious cardiovascular conditions: ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), ischemic stroke (IS), hemorrhagic stroke (HS), and heart failure (HF). We calculated weekly ratios of ED visits in 2020 to visits in 2019 in the pre-pandemic (Jan 1-March 10), early-pandemic (March 11-April 21), and later-pandemic (April 22-October 31) periods.
ED visit ratios show that NSTEMI, IS, and HF visits dropped to lows of 56%, 64%, and 61% of 2019 levels, respectively, in the early-pandemic and gradually returned to 2019 levels over the next several months. HS visits also dropped early pandemic period to 60% of 2019 levels, but quickly rebounded. We find mixed evidence on whether STEMI visits fell, relative to pre-pandemic rates. Total adult ED visits nadired at 57% of 2019 volume during the early-pandemic period and have only party recovered since, to approximately 84% of 2019 by the end of October 2020.
We confirm prior studies that ED visits for serious cardiovascular conditions declined early in the COVID-19 pandemic for NSTEMI, IS, HS, and HF, but not for STEMI. Delays or non-receipt in ED care may have led to worse outcomes.
我们在美国 18 个州的 108 家急诊室中，对 115716 例患有五种严重心血管疾病（ST 段抬高型心肌梗死 [STEMI]、非 ST 段抬高型心肌梗死 [NSTEMI]、缺血性中风 [IS]、出血性中风 [HS]和心力衰竭 [HF]）的成年急诊患者的 2020 年 ED 就诊情况进行分析，以研究与 2019 年相比，在冠状病毒（COVID-19）大流行期间，1 月至 10 月期间严重心血管疾病在急诊科就诊的情况发生了怎样的变化。
我们比较了 2020 年 COVID-19 大流行前和大流行期间的 ED 就诊情况，以及 115716 例患有五种严重心血管疾病的成年 ED 就诊患者的 2019 年就诊情况。我们计算了 2020 年每个星期的就诊比例，将其与大流行前（1 月 1 日至 3 月 10 日）、大流行早期（3 月 11 日至 4 月 21 日）和大流行后期（4 月 22 日至 10 月 31 日）的就诊比例进行比较。
ED 就诊比例显示，NSTEMI、IS 和 HF 的就诊比例分别降至 2019 年水平的 56%、64%和 61%，这三种疾病在大流行早期均达到最低水平，随后在接下来的几个月中逐渐恢复到 2019 年的水平。HS 就诊比例在大流行早期也降至 2019 年水平的 60%，但很快反弹。关于 STEMI 的就诊比例是否下降，我们发现了一些相互矛盾的证据，与大流行前的就诊率相比。总的成年 ED 就诊量在大流行早期达到 2019 年水平的 57%，此后仅部分恢复，截至 2020 年 10 月底，恢复至 2019 年水平的 84%左右。
我们证实了之前的研究结果，即 COVID-19 大流行早期，NSTEMI、IS、HS 和 HF 的 ED 就诊量下降，但 STEMI 就诊量没有下降。ED 护理的延迟或未得到护理可能导致了更差的结果。
