Increased Inpatient Mortality for Cardiovascular Patients During the First Wave of the COVID-19 Epidemic in New York.
Increased Inpatient Mortality for Cardiovascular Patients During the First Wave of the COVID-19 Epidemic in New York.
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DOI：
10.1161/jaha.120.020255
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发表时间：
2021-08-17
影响因子：
5.4
通讯作者：
Kuvin J
中科院分区：
文献类型：
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作者：
Mountantonakis SE;Makker P;Saleh M;Coleman KM;Husk G;Jauhar R;Singh V;Epstein LM;Kuvin J
纽约第一波新冠肺炎疫情的敏锐性和规模迫使医疗保健获取和提供方式发生了巨大变化。我们回顾研究了2020年3月11日至5月26日(第一波新冠肺炎疫情)和2019年同期，诺斯韦尔健康公司的13家医院收治的以急性心血管综合征为主要诊断的患者。316例(242例新冠肺炎阳性)患者在第一次新冠肺炎波期间因急性心血管综合征入院，而一年前为9422例(减少68.0%，P<；0.001)。在此期间，心血管疾病患者出现在医院的时间较晚(急性心肌梗死患者为120分钟)，接受手术较少(34.6%对45.6%，P<；0.001)，不太可能在重症监护病房接受治疗(8.7%对10.8%，P<；0.001)，住院时间较长(2.91[1.71-6.05]天对2.87[1.82-4.95]天，P=0.033)。在第一次疫情暴发期间，住院的心血管疾病死亡率增加了111.1%(3.8vs1.8P<；0.001)，与纽约与新冠肺炎相关的入院、全因住院死亡或院外心脏病死亡发生率无关。首次新冠肺炎入院人数激增与年龄和新冠肺炎试验阳性一起独立预测心血管疾病入院患者的死亡率(优势比分别为1.3、1.05和5.09，P<；0.0001)。较低的心血管病理患者发生率和较晚的表现，再加上第一波新冠肺炎大流行要求的与常规临床做法的背离，可能是同期住院心血管死亡率较高的原因。
The acuity and magnitude of the first wave of the COVID‐19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID‐19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID‐19 positive) were admitted for an acute cardiovascular syndrome during the first COVID‐19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71–6.05] versus 2.87 [1.82–4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID‐19‐related admissions, all cause in‐hospital mortality, or incidence of out‐of‐hospital cardiac deaths in New York. Admission during the first COVID‐19 surge along with age and positive COVID‐19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001). A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID‐19 pandemic, might have accounted for higher in‐hospital cardiovascular mortality during that period.