The COVID-19 pandemic caused substantial global declines in cardiovascular care, with low-middle income countries experiencing a more severe decline in STEMI hospitalizations than high-income countries (RR 0.79; 95% CI 0.66-0.94).
Meta-Analysis
Yes
Did the COVID-19 pandemic affect cardiovascular disease hospitalizations, procedures, and mortality compared to the pre-pandemic period?
The COVID-19 pandemic led to significant global reductions in cardiovascular healthcare utilization and increased in-hospital mortality for STEMI and heart failure, particularly in low-middle income countries.
Effect estimate: RR 0.79 (95% CI 0.66-0.94)
AIMS: The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS: From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval CI 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS: There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
Nadarajah et al. (Thu,) conducted a meta-analysis in Non-COVID-19 cardiovascular diseases. COVID-19 pandemic period vs. Pre-pandemic period was evaluated on STEMI hospitalisations in low-middle income countries compared to high-income countries (RR 0.79, 95% CI 0.66-0.94). The COVID-19 pandemic caused substantial global declines in cardiovascular care, with low-middle income countries experiencing a more severe decline in STEMI hospitalizations than high-income countries (RR 0.79; 95% CI 0.66-0.94).