Emergency department visits due to coronary artery disease during COVID-19 in Finland: A register-based study

Aims: This multi-centre study examined the effects of restricted availability of health-care services during the COVID-19 pandemic on treatment of coronary artery disease (CAD) in Finland. Methods: Data on referrals to cardiological units (n=81,008), emergency department (ED) visits (n=10,001) and hospitalisations (n=8654) for CAD were collected from three large Finnish hospitals, and incidences were calculated per 100,000 persons for the years 2017 through 2020. Year 2020 was compared to the reference years 2017-2019 by incidence rate ratios (IRR) with 95% confidence intervals (CI). Results: Referrals to cardiological units decreased after the onset of the pandemic in March to May (IRR=0.83, 95% CI 0.81-0.86). ED visits due to acute coronary syndrome decreased during the first months of the pandemic, with the overall annual incidence 2-14% lower than in the reference years. ED visits due to chronic CAD increased prominently during in April and May compared to the corresponding months in the reference years (IRR=1.49, 95% CI 1.23-1.81 in April; IRR=1.57, 95% CI 1.32-1.89 in May) and remained elevated until the end of 2020, with an increase in annual incidence of 17% (IRR=1.17, 95% CI 1.11-1.24). Conclusions: The first COVID-19 wave decreased ED visits due to acute coronary syndromes and increased those due to chronic CAD. The changes in referral and ED visit incidences during the second wave were rather modest.