How does SARS-CoV-2 infection affect survival among patients with cardiovascular emergencies?

Abstract

Objective

A previous study revealed a preliminary trend towards higher in-hospital mortality in patients emergently admitted with acute stroke during the COVID-19 pandemic in Germany. The current study aims to further examine the possible impact of a confirmed SARS-CoV-2 infection on in-hospital mortality.

Methods

This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), aortic rupture, acute stroke, or transient ischaemic attack (TIA) between January 1, 2017, and October 31, 2020, were included. Admission rates per 10,000 insured and mortality were compared between March-June 2017-2019 (pre-COVID) and March-June 2020 (COVID). Mortality rates were determined by the occurrence of a confirmed SARS-CoV-2 infection.

Results

A total of 316,718 hospitalizations were included (48.7% female, mean 72.5 years), and 21,191 (6.7%, 95% CI 6.6-6.8%) deaths occurred. In-hospital mortality increased during the COVID-19 pandemic when compared to the three previous years for patients with acute stroke from 8.3% (95% CI 8.0-8.5) to 9.6% (95% CI 9.1-10.2) while no significant changes were observed for STEMI, NSTEMI, ALI, aortic rupture, and TIA. When comparing patients with confirmed SARS-CoV-2 infection (2.4%, 95% CI 2.3-2.5) vs. non-infected patients, a higher in-hospital mortality was observed for acute stroke (12.4% vs. 9.0%), ALI (14.3% vs. 5.0%), and TIA (2.7% vs. 0.3%) while no statistically significant differences were observed for STEMI, NSTEMI, and aortic rupture.

Conclusion

This retrospective analysis of claims data provided hints for an association of COVID-19 pandemic with increased in-hospital mortality in patients with acute stroke. Furthermore, confirmed SARS-CoV-2 infection was associated with increased mortality in patients with stroke, TIA, and ALI. Future studies are urgently needed to better understand the underlying mechanism and relationship between the new coronavirus and acute stroke.