A new study shows a dramatic decrease in cases of type A aortic dissection in New York City during the COVID-19 pandemic coinciding with an increase in in-home deaths.
Ismail El-Hamamsy, MD, PhD, of the Icahn School of Medicine at Mount Sinai, and colleagues reported the findings in an article that was recently published in the Journal of the American College of Cardiology.
This small study collected surgical data from all the hospitals and health systems that provide surgical correction of aortic dissection repair that is treated surgically. Data were collected retrospectively from Jan. 1, 2018, through April 15, 2020. A comparison was performed, using invariable linear regression, with March 1, 2020, as the cutoff date. Cases before March 1 were considered “before COVID,” and cases from March 1 on were considered “after COVID.” March 1 was when the first case of COVID-19 was reported in New York City.
The investigators found a 76.5% decrease in type A dissection monthly surgical case volumes using regression analysis, from a mean of 12.8 cases per month before March 1 to a mean of 3 cases per month afterward. This was found to be statistically significant (absolute difference, 9.8 cases per month; 95% confidence interval, 2.95-16.67; p=0.007).
The authors write that this trend, along with an increase of in-home deaths in the city since the last week of March, is cause for concern. They did, however, note, that these data alone do not definitely state that there is a connection between the decrease in reported type A dissection cases and increase in in-home deaths.
As people fear the pandemic, it may prompt them to avoid seeking help for emergent conditions, which could prove fatal in the worst-case scenario. Other hypotheses concerning these findings are the immense burden on emergency department and personnel, causing delay in diagnosis or timely transportation to the emergency department, the authors write.
“This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as in future similar events,” El-Hamamsy and colleagues conclude.
El-Hamamsy I, Brinster DR, DeRos JJ, et al. The COVID-19 Pandemic and Acute Aortic Dissections in New York: A Matter of Public Health. J Am Coll Cardiol 2020 May 14. https://doi.org/10.1016/j.jacc.2020.05.022