An assessment of emergency department visits for cardiovascular diseases in the early phase of the COVID-19 pandemic in Istanbul

Objectives: The coronavirus disease (COVID-19) pandemic has had a severe impact with an excess of one hundred million cases and over two million deaths worldwide. Countries have adopted different paths toward 'flattening the curve'; however, many countries observed a common trend of people avoiding emergency departments (ED) for varying reasons. This study aims to investigate the ED utilization patterns of patients with cardiovascular diseases (CVD) in the early phases of COVID-19 in Istanbul, Turkey. Methods: The data were retrospectively collected in eight hospitals, which were authorized and declared as pandemic hospitals by the Turkish Ministry of Health. The data for these two particular periods of 1st March-30th June were compared between 2019 and 2020. Results: A substantial and statistically significant decrease of 22.7% was observed in the total number of visits to EDs for cases of CVD from 534 cases in 2019 to 413 cases in 2020. ED visits showed statistically insignificant decreases of 11.6% for acute coronary syndrome/ACS) and 30.6% for cerebrovascular events (CVE) between 2019 and 2020. Of the total 422 ACS cases, 67.8% were male and 32.2% were female; and of the 525 CVE cases, 50.3% were male and 49.7% were female. The median ages were 61 [6-97] for men and 69 [19-103] for women; the median ages were 59 [19-97] for patients with ACS and 68 [6-103] for patients with CVE. In 2020, the number of ACS cases showed a steady trend between March 1st and June 30th, followed by a prominent increase in June 2020. The monthly trends appeared to be very similar for CVE cases for 2019 and 2020. Of the 379 hospitalizations, 56.2% were diagnosed with ACS and 43.8% with CVE. Conclusions: The findings suggest that patients tended to avoid timely medical care during the pandemic compared to pre-COVID-19. Stay-at-home orders and attempts to avoid contact with the virus may explain the dramatic decrease in the number of ED visits.