Therapeutic Advances in Neurological Disorders (Jul 2021)

Persistent decline of hospitalizations for acute stroke and acute coronary syndrome during the second wave of the COVID-19 pandemic in Greece: collateral damage unaffected

  • Christos Katsouras,
  • Georgios Tsivgoulis,
  • Michail Papafaklis,
  • Theodore Karapanayiotides,
  • Dimitrios Alexopoulos,
  • Evangelos Ntais,
  • Georgia Papagiannopoulou,
  • Ioanna Koutroulou,
  • Antonios Ziakas,
  • Georgios Sianos,
  • Antonios Kouparanis,
  • Paraskevi Trivilou,
  • Christos Ballas,
  • Ioanna Samara,
  • Maria Kosmidou,
  • Lina Palaiodimou,
  • Nikolaos Grigoriadis,
  • Lampros K. Michalis,
  • Sotirios Giannopoulos

DOI
https://doi.org/10.1177/17562864211029540
Journal volume & issue
Vol. 14

Abstract

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Background: An alarming cerebro/cardiovascular collateral damage, reflected by a decline in admissions for acute stroke (AS) and acute coronary syndrome (ACS), was observed during the initial phase of the COVID-19 pandemic, thereby leading to a re-design of public campaigns. However, there are limited data regarding the AS and ACS hospitalization rates during the second wave of the pandemic, which was followed by re-imposition of lockdowns. Methods: We calculated the rate of AS and ACS hospitalizations from three representative tertiary care hospitals in Greece during a 2-month period (November–December 2020) of the second wave of the COVID-19 pandemic compared with the corresponding control period in 2019 from three representative tertiary care hospitals in Greece. This was a follow-up study with identical design to our previous report evaluating AS and ACS hospitalizations during the first wave of the pandemic (March–April 2020). Results: Compared with 2019, there was a 34% relative reduction of AS hospitalizations [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.48–0.92, p = 0.013] and 33% relative reduction of ACS hospitalizations (IRR: 0.67, 95% CI: 0.54–0.83, p < 0.001) during the second wave of the COVID-19 pandemic. The relative reduction was smaller and did not reach the level of statistical significance for the respective syndromes (haemorrhagic stroke: IRR 0.87, 95% CI: 0.41–1.82, p = 0.71; ST-elevation myocardial infarction: IRR 0.81, 95% CI: 0.57–1.14, p = 0.22). Conclusion: AS and ACS hospitalizations were persistently reduced during the second wave of the COVID-19 pandemic compared with 2019 in Greece. This decline was similar to the observations during the first wave despite the large differences in the epidemiological COVID-19 burden. Lockdowns, a common characteristic in both waves, appear to have a detrimental indirect impact on cerebro/cardiovascular diseases in the general population.