Short Term Outcomes and Treatment Intensity of Major Cardiovascular Emergencies During the SARS-CoV2 Pandemic in Germany

Objective There has been a decline in hospital admission rates in many countries since the beginning of the SARS-CoV-2 pandemic. Thereby, the patient selection differed from episodes before the pandemic. This study investigates changes in baseline characteristics as well as short term mortality and probability of receiving an invasive procedure while considering sex disparities. Methods Claims data provided by Germany’s second largest insurance fund, BARMER, were used. Patients without COVID-19 who were treated for ST segment elevation (STEMI) and non-elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), and stroke between 1 January 2018 and 31 December 2021 were included. Outcomes were compared separately for both sexes between the years before the pandemic (2018/2019) and during the pandemic (2020/2021). Propensity scores with exact matching were used to balance confounders including age, drug prescriptions in previous year, federal state, month of admission, domiciliary care, and the Elixhauser comorbidities. Short term mortality and probability of invasive procedures were determined using cumulative incidence functions and Cox regressions. Results The cohort consisted of 140 989 hospitalisations of 122 340 individual patients (48.3% females) with 102 960 matched cases. Baseline characteristics were similar between episodes in the unmatched cohort. Earlier discharge was observed for all strata except for males with ALI or STEMI, where the probability of early discharge was unchanged. The probability of receiving an invasive procedure was increased for both sexes with ALI, NSTEMI, and STEMI but not for stroke. The analyses suggested neither a statistically significant increase of in hospital mortality nor 30 day mortality since the pandemic started. Conclusion There was no evidence for a direct or indirect impact of the pandemic on major short term hospital outcomes. While the probability of receiving an invasive procedure increased for STEMI, NSTEMI, and ALI, the overall short term mortality was unaffected for both sexes.