Impact of coronavirus disease 19 (COVID-19) pandemic on age differences of acute coronary syndromes admissions and in-hospital outcomes

Background Multiple studies documented a significant reduction in acute coronary syndrome (ACS) admissions during the COVID-19 pandemic. Few studies have examined age differences in ACS admissions and outcomes during and after the initial lockdown, yielding divergent results. Purpose This study aimed to investigate age differences in ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period in Albania. Methods A retrospective single-center study was conducted, enrolling consecutive patients diagnosed with ACS. Data for all admissions were collected from March 9th (the date of the first COVID-19 case) until April 30th, covering three consecutive years from 2019 to 2021. The control period was 2019, with study periods in 2020 (during the lockdown) and 2021 (during the ongoing pandemic). Patients were grouped by age: <70 and ≥70 years old. Incidence rate ratio (IRR [95%CI]) was used to compare admissions, and risk ratio (RR [95%CI]) to compare the mortality between study periods and the control period. Results A total of 1539 patients diagnosed with ACS were included: 550 patients in 2019, 321 in 2020, and 668 in 2021. The IRR for ACS admissions in each age group (<70 and ≥70 years) was significantly lower during the 2020 lockdown compared to 2019, with values of 0.59 (0.48-0.81) and 0.54 (0.34-0.70), respectively. An increase in ACS admissions for those <70 years was noted in 2021, with an IRR of 1.37 (1.09-1.6) compared to 2019. Mortality for ACS patients ≥70 years significantly increased to 13.8 % from 7.0% (RR=1.97; p=0.04) during the lockdown (2020) compared to the pre-pandemic period. For the <70 years group, mortality increased to 5.7% from 1.1%, although not significantly (RR=2.46, p=0.16). Mortality rates in 2021 were similar to those in 2019, at 2.0% vs. 1.1% (RR=1.65; p=0.40) for <70 years and 4.8% vs. 7.0% (RR=0.68; p=0.34) for ≥70 years. Conclusions Following the initial reduction in ACS admissions across both age groups, the mortality significantly increased in patients over 70 years during the 2020 lockdown. A rebound in admissions for those <70 years occurred in 2021 alongside similar mortality rates in both age groups. Mortality was consistently higher in elderly patients across all periods, with the COVID-19 lockdown inflicting greater collateral damage.