The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Amo...

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Bibliographic Details
Published in:PloS one 2021-10, Vol.16 (10), p.e0257910-e0257910
Main Authors: Rossi, Camillo, Berta, Paolo, Curello, Salvatore, Lovaglio, Pietro Giorgio, Magoni, Mauro, Metra, Marco, Roccaro, Aldo Maria, Verzillo, Stefano, Vittadini, Giorgio
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Care and treatment
Cerebral infarction
Control
Coronaviruses
COVID-19
Discontinuity
Emergencies
Emergency medical care
Emergency medical services
Epidemics
Heart attack
Heart attacks
Hospitalization
Hospitals
Infections
Italy
Medicine and Health Sciences
Mortality
Myocardial infarction
Pandemics
Patient admissions
Patient outcomes
Patients
Seasonal variations
Statistical analysis
Stroke
Stroke (Disease)
Viral diseases
Windows (intervals)
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Summary:The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. We check, in a causal inference framework, the causal effect of the hospital's stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9.sup.th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0257910