The COVID-19 pandemic, at least in its early stages, it was characterized by reduced access to health care, potentially delaying early treatment of cardiovascular disease.

On the other hand, SARS-CoV-2 infection, as a systemic disease that can affect a range of organs, is associated with higher rates of heart failure, myocardial infarction, and stroke.

The doctors of the Therapeutic Clinic of the School of Medicine of the National and Kapodistrian University of Athens, Theodora Psaltopoulou (professor of Epidemiology and Preventive Medicine) and Giannis Danasis summarize the scientific data published on January 5, 2024 in the prestigious international journal JAMA Health Forum on the epidemiology and characteristics of acute cardiovascular events during the COVID-19 pandemic.

The researchers collected data from Harvard Pilgrim Health Care, which has more than 1 million members insured in the New England region (Massachusetts, New Hampshire, Maine, Connecticut) in the US.

The data related to hospitalizations for myocardial infarction and stroke during the time period from March 2017 to December 2021. Specifically, cardiovascular events such as heart attacks, strokes, episodes of congestive heart failure, angina pectoris and transient ischemic attack were recorded.

Complex, acute cardiovascular problems decreased during the initial phase of the pandemic in April 2020 by 26.6%. Rates remained below expected levels in March 2021 (-9.6%) and December 2021 (-19.8%).

Stroke hospitalizations initially fell by 27.0%, remained lower than expected in February 2021 (-11.8%) and were lower than expected in December 2021 (-27.3%).

Hospitalizations for myocardial infarction decreased initially by 27.8%, but were not statistically different from expected levels in January 2021. Congestive heart failure episodes initially decreased by 26.1%, were lower than expected levels in March 2021 (-15.8%) and was lower than expected by December 2021 (-22.1%). Angina episodes followed similar trends of sustained decline, while transient ischemic attack events were not significantly different than expected through August 2020.

Overall, the COVID-19 pandemic was not associated with a long-term increase in cardiovascular events among insured residents of New England, USA, but, instead, sustained reductions in episodes of transient ischemic attack, congestive heart failure, and angina were identified.

Possible reasons that explain these trends are:

  • lack of hospital attendance during the study’s 21-month follow-up (for example, fear of getting infected);
  • cardiovascular deaths occur outside the medical system (e.g. at home);
  • deaths of individuals from COVID-19, while at the same time being at risk for major cardiovascular events;
  • reduction in overdiagnosis due to lower emergency department attendance;
  • home management of heart failure and other illnesses at home;

The present study, in conjunction with other studies, shows that in the US some states had an increase and others a decrease in cardiovascular events during the pandemic. Most important for health policy makers is to facilitate access to health systems for patients with cardiovascular disease and other serious illnesses that require hospital treatment, during periods of limited access to health care (such as in the first period of the pandemic).