The COVID-19 lockdown: a curse or a blessing for acute cardiovascular disease?

Abstract

In this issue of the Netherlands Heart Journal, de Koning et al. [1] report a significantly reduced number of ambulance rides for chest pain and ST-elevation myocardial infarction during the first 6 weeks of the national lockdown due to the coronavirus disease 2019 (COVID-19) pandemic in the Hollands-Midden region of the Netherlands. The incidence of out-ofhospital cardiac arrest remained the same as in the same period in 2019. Others have reported similar findings. In August 2020, Solomon et al. reported an alarming decrease in the number of hospitalisations for acute myocardial infarctions in Northern California, with an incidence rate ratio of 0.52 (95% confidence interval 0.40–0.68) in April 2020, compared with January–February 2020 [2]. Moreover, similar observations came from studies that investigated the incidence of other acute cardiovascular events, such as ischaemic stroke. A small study performed in Ohio compared the number of stroke alerts in February 2020 with January 2020 and found a significant decrease in daily stroke alerts, stroke diagnoses and intravenous thrombolysis performed at the emergency department, but no difference in intra-arterial thrombectomies [3]. Similarly, a population-based study in Brazil showed a significant reduction in patients presenting at the emergency room with transient ischaemic attack and mild-tomoderate stroke, but not for severe stroke since the lockdown measures were implemented [4].