Emergency department visits, care, and outcome after stroke and myocardial infarction during the COVID-19 pandemic phases

Background — It is not known if initial reductions in hospitalization for stroke and myocardial infarction early during the COVID-19 pandemic were followed by subsequent increases. We describe the rates of emergency department visits for stroke and myocardial infarction through the pandemic phases.

Methods — We used linked administrative data to compare the weekly age- and sex-standardized rates of visits for stroke and myocardial infarction in Ontario, Canada in the first nine months of 2020 to the mean baseline rates (2015-2019) using rate ratios (RR) and 95% confidence intervals (CI). We compared care and outcomes by pandemic phases (pre-pandemic was January-March, lockdown was March-May, early re-opening was May-July, and late re-opening was July-September).

Results — We identified 15,682 visits in 2020 for ischemic stroke (59.2%, n=9,279), intracerebral hemorrhage (12.2%, n=1,912), or myocardial infarction (28.6%, n=4,491). The weekly rates for stroke visits in 2020 were lower during the lockdown and early re-opening than baseline (RR 0.76 95%CI [0.66, 0.87] for the largest weekly decrease). The weekly rates for myocardial infarction visits were lower during the lockdown only (RR 0.61 95%CI [0.46, 0.77] for the largest weekly decrease) and there was a compensatory increase in visits following re-opening. Ischemic stroke 30-day mortality was increased during the lockdown phase (11.5% pre-COVID, 12.2% lockdown, 9.2% early re-opening, and 10.6% late re-opening, p=0.015).

Conclusion — After an initial reduction in visits for stroke and myocardial infarction, there was a compensatory increase in visits for myocardial infarction. Death after ischemic stroke was higher during the lockdown than other phases.

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