key: cord-1028099-xbja4xk0
authors: Kiblboeck, Daniel; Kellermair, Joerg; Siostrzonek, Peter; Steinwender, Clemens
title: Regional differences in hospital admissions for ST-elevation and non-ST-elevation myocardial infarctions during the Coronavirus disease-19 (COVID-19) pandemic in Austria
date: 2020-06-12
journal: Wien Klin Wochenschr
DOI: 10.1007/s00508-020-01698-7
sha: 50d8fd3411332447e3aa6462186a81225e997494
doc_id: 1028099
cord_uid: xbja4xk0

nan

the lockdown (weeks 10 and 11) compared to after the lockdown (weeks 12 and 13) decreased by 21% (STEMI: weeks 10 + 11: n = 208, weeks 12 + 13: n = 164, Δ = -44) and by 44% (NSTEMI: weeks 10 + 11: n = 259, weeks 12 + 13: n = 146, Δ = -113), respectively. The number of STEMI and NSTEMI hospital admissions per week showed a strong negative correlation with the total number of confirmed COVID-19 infections (Spearman r = -1.0, p = 0.08). A strong decrease of ACS (STEMI and NSTEMI) was observed in all Austrian states (Fig. 1b) . Remarkably, a stronger decrease was observed in West Austria with higher COVID-19 incidences (Tyrol, Vorarlberg, Salzburg) compared to East Austria with lower COVID-19 incidences (Upper Austria, Lower Austria, Styria, Vienna, Burgenland and Carinthia). The incidence of STEMI decreased by 29% in West Austria (weeks 10 + 11: n = 51, weeks 12 + 13: n = 36, Δ = -15) and by 19% in East Austria (weeks 10 + 11: n = 157, weeks 12 + 13: n = 128, Δ = -29), NSTEMI decreased by 65% in West Austria (weeks 10 + 11: n = 49, weeks 12+13: n = 17, Δ = -32) and by 39% in East Austria (weeks 10 + 11: n = 210, weeks 12 + 13: n = 129, Δ = -81) (Fig. 1c) .

Cardiac catheterization centers around the world have reported dramatic declines in patients admitted to hospital for STEMI and NSTEMI during the COVID-19 pandemic [3, 4] .

Two different reasons may have contributed to this observation. First, governmental regulations (stay at home order, social distancing, quarantine) might have led to an actual decrease of STEMI and NSTEMI by less physical activity, less emotional stress in home office, less fine dust exposure and less non-SARS-CoV-2 viral infections, all potentially triggering ACS. Second, patient and health care-related factors (e.g. fear of infections, difficult access to health care specialists) have led to an unintended underdiagnosis of ischemic events. In any case, the observed decline of STEMI Fig. 1 a COVID-19 incidence per 100,000 inhabitants in different states of Austria [6] . and NSTEMI hospital admissions is a cause for concern, as a higher than usual proportion of untreated patients with ACS may result in an increased mortality due to arrhythmias and heart failure [5] .

In conclusion, our survey demonstrates that the COVID-19 pandemic in Austria led to fewer hospital admissions for STEMI and NSTEMI with an even higher decrease in West Austria with higher COVID-19 incidences.

Gudrun Lamm; Wels: Klinikum Wels-Grieskrichen

Krankenhaus Rudolfstiftung, 2. Abteilung mit Kardiologie

A novel coronavirus emerging in China-key questions for impact assessment

Facing Covid-19 in Italy-ethics, logistics, and therapeutics on the epidemic's front line

Reduction in STsegment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic

Impact of the COVID-19 pandemic on interventional cardiology activity in Spain

Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage

Federal Ministry Republic of Austria Social Affairs, Health, Care and ConsumerProtection

Conflict of interest D. Kiblboeck, J. Kellermair, P. Siostrzonek and C. Steinwender declare that they have no competing interests.