Emergency hospital admissions and interventional treatments for heart failure and cardiac arrhythmias in Germany during the Covid-19 outbreak: insights from the German-wide Helios hospital network

Abstract

A reduction of hospital admissions for acute coronary syndromes in association with reduced cardiac catheterizations has been observed in Europe1–3 and the USA4 during the Covid-19 pandemic. There is growing concern that this may be accompanied by a substantial increase in early and late infarct-related morbidity and mortality. Heart failure and cardiac arrhythmias are also frequent causes for emergency hospital admissions, but the impact of the Covid-19 pandemic on admission rates and interventional treatments is unknown. Consequently, we performed a retrospective analysis of claims data of 66 Helios hospitals in Germany.5 Consecutive completed cases with an emergency hospital admission between 1 March 2020 and 30 April 2020 (study period), 1 March 2019 and 30 April 2019 (previous year control), and 1 January 2020 and 28 February 2020 (same year control) were studied. Data were stored in a pseudonomymized form, and data use was approved by the Helios hospitals data protection authority. Aggregate data underlying this article are available in the article. Cause-specific hospitalizations were defined on the basis of primary diagnosis according to International Statistical Classification of Diseases and Related Health Problems [ICD-10-GM (German Modification)] codes for heart failure (I42.x; I43.x; I50.x), bradycardias (including cardiac conduction disease; I44.x, I45.0 – I45.5, I45.9, I49.5, R00.1), atrial fibrillation/flutter (I48.x), supraventricular (I45.6, I47.1, R00.0), and ventricular tachyarrhythmias (I47.0, I47.2, I49.0, I49.3). Interventional treatments were defined according to the German procedure classification (‘Operationen und Prozedurenschlüssel’, OPS) for catheter ablations (8-835) and implantation of cardiac rhythm management devices (CRM devices; pacemakers, defibrillators, and event recorders; 5-377, 5-378). Incidence rates for cause-specific admissions and interventions were calculated by dividing the number of cumulative cases by the number of days for each time period. Incidence-rate ratios comparing the study period to each of the control periods were calculated using Poisson generalized linear mixed models to model the number cause-specific emergency hospitalizations and interventional treatments per day. A total of 17 417 emergency hospital admissions (10 215 for heart failure, 7202 for cardiac arrhythmias) and 1832 interventions (749 ablations, 1083 implants) were included. Emergency admissions declined during Covid-19 outbreak by 22–28% for heart failure and 13–27% for cardiac arrhythmias. This was accompanied by a 15–27% reduction in interventional treatments (Table 1). Comparison of emergency hospital admissions for heart failure and cardiac arrhythmias as well as interventional treatments in the German-wide Helios hospital network between the Covid-19 outbreak and two control periods CI, confidence interval; CRM, cardiac rhythm management; IR, incidence rate. To the best of our knowledge, this report is the first that analyses emergency hospitalizations and interventional treatments for heart failure and cardiac arrhythmias in the largest German hospital network during the Covid-19 pandemic. In agreement with previous studies focusing on acute coronary syndromes and cardiac catheterization,1–4 a significant decrease in emergency hospitalization and interventional treatments has been observed. The contribution of this finding to acute, i.e. in-hospital or excess mortality not fully explained by Covid-19 cases alone, and long-term morbidity and mortality deserves further studies. Conflict of interest: none declared.

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