key: cord-0744141-titihw6h
authors: Bollmann, Andreas; Pellissier, Vincent; Hohenstein, Sven; König, Sebastian; Ueberham, Laura; Meier-Hellmann, Andreas; Kuhlen, Ralf; Thiele, Holger; Hindricks, Gerhard
title: Cumulative hospitalization deficit for cardiovascular disorders in Germany during the Covid-19 pandemic
date: 2020-08-28
journal: Eur Heart J Qual Care Clin Outcomes
DOI: 10.1093/ehjqcco/qcaa071
sha: 47ea777514aad28065ecac937c08f607eca8b4e1
doc_id: 744141
cord_uid: titihw6h

nan

During the early phase of the Covid-19 pandemic, reductions of hospital admissions have been shown for several cardiovascular disorders including acute coronary syndromes, heart failure and cardiac arrhythmias in Europe 1-3 and the U.S. 4 However, there is only scarce data on hospitalization trends during the course of the pandemic that is, moreover, limited to acute coronary syndromes. [2] [3] [4] Consequently, the aim of this correspondence is to illustrate hospitalizations for several acute and chronic cardiovascular conditions and thereby to introduce the cumulative hospitalization deficit as novel metric to monitor hospitalizations as the pandemic continues.

Thus, we performed a retrospective analysis of claims data of 82 Helios hospitals in Germany. 5 Consecutive cases with a hospital admission between March 13, 2020 (the begin of the protection stage according to the German pandemic plan) and July 16, 2020 (study period) were studied and compared to a corresponding period covering the same weeks in Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage (95% confidence interval [CI] ) of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. The difference between the expected and observed cumulative admission number was assessed using a χ 2 test for the admission nadir defined as the week with the lowest admission number and the last week of the study period. The p values were adjusted for multiple comparisons using a Bonferroni correction.

A total of 139,041 hospital admissions (62,606 during the study and 76,435 during the control period) were included. There was a decline in hospitalizations during the early phase of the study period leading to an increase in the cumulative hospitalization deficit across all analyzed diseases until the nadir (Figure 1 ). The nadir was reached in the week April 10-16, 2020 for all conditions except for heart failure (March 20-26, 2020) and hypertension (March 27-April 2, 2020). During the nadir, weekly hospitalizations were reduced by 28-43% (Table   1 ). Thereafter, the cumulative hospitalization deficit decreased to -17-20% at the end of the study period ( Figure 1 , Table 1 ).

To the best of our knowledge, this report that analyzes hospitalizations for several cardiovascular conditions has several strengths, i.e. it uses the largest German hospital network during 4 months of the Covid-19 pandemic, the longest observation period so far.

In agreement with previous studies, 1-4 a significant decrease of hospitalizations reaching 43 % has been observed. Our analysis confirms and extends findings from very recent studies focussing on acute coronary syndromes. These studies have reported a recovery phase with cases reaching almost previous year control period values. However, as can be appreciated from our analysis, there remains a substantial deficit in cumulative hospital admissions.

The long-term consequences of those observations deserve further studies. In that respect, delayed diagnosis of acute or deterioration of chronic cardiovascular disorders followed by increased admissions, and higher morbidity and mortality is a potential future scenario for Legends Table 1 . Cumulative hospitalization deficit for several cardiovascular conditions in the German-wide Helios hospital network at the nadir and in mid July 2020 during the Covid-19 pandemic. 

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In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures