INCREASED CARDIOVASCULAR DEATH RATES IN A COVID-19 LOW PREVALENCE AREA

Objective: Preliminary data indicate a reduction in hospitalizations for acute coronary syndromes during the Covid19 outbreak in Northern Italy. We investigated whether the albeit marginal Covid19 burden in the province of L Aquila in Central Italy, had an impact on cardiovascular hospitalizations and outcomes Design and method: We retrospectively analyzed de-identi fied data from all patients admitted to the five hospitals located in the province of L Aquila for allcause and cardiovascular hospitalizations, cardiovascular acute phase treatments (coronary angioplasty, systemic fibrinolysis, endovascular procedures), and inhospital cardiovascular deaths in the time window from January 1 to March 31 in the years 2020 (study period) and 2019 (control period). Unadjusted incidence rate ratios (IRR) comparing study/control period for the number of admissions/ procedures were calculated through Poisson regression. Case fatality rate (%) for cardiovascular diseases in the examined periods was assessed Results: 5908 patients were hospitalized in the first quarter of 2020 (52.9% women mean age 59.2±24.9 years, 64.9 mean daily admissions). In the same period in 2019, 6852 patients were hospitalized (51.8% women, mean age 60.1±24.6 years;76.1 mean daily admissions). Signi ficantly less all-cause and cardiovascular hospitalizations occurred in the study period than in the control period (IRR 0.85 95%CI 0.82-0.88;IRR 0.73, 95%CI 0.67-0.80, respectively). The mean daily number of cardiovascular procedures was also lower (IRR: 0.74, p=0.009). Importantly a disproportionate decrease in the number of procedures was observed in relation to cardiovascular hospitalizations in the study period (13.8% versus 19.3%, p=0.001). More intra-hospital cardiovascular deaths occurred in March 2020 (11.9%) compared with March 2019 (6.1%) (p=0.048) Conclusions: Changes in healthcare seeking behaviors and an increased burden of cardiovascular-related deaths occurred in a Covid19 low prevalence Italian area Besides unmeasured factors, including forced lifestyle changes, late hospital presentations and consequent greater disease severity might have affected eligibility and outcome of cardiovascular procedures. This evidence advances recent concerns regarding the impact of the pandemic on cardiovascular diseases and related deaths.