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

The Covid-19 pandemic has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world for both Covid and no-Covid patients. In this context, it is extremely important to assess whether the clinical management of no-Covid cases has not seriously been compromised during the first epidemic outbreak. Among no-Covid cases, patients with acute myocardial infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates as no-Covid patients to be studied. Preliminary evidence suggests that i) the time from onset of symptoms to emergency department (ED) presentation has increased in Covid-19 times as well as 30-day mortality during the pandemic has been higher. We aimed to complement this evidence assessing if the additional stress due to the high inflow of Covid-19 patients at hospital level has modified AMI and Stroke admission criteria and related mortality rates in a causal inference framework. We adopt two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs by which we identify the plausible causal effect on mortality of the Covid-19-related hospital stress due to the introduction of State of Emergency restrictions. Despite the potential adverse effect on expected mortality due to a longer time to hospitalization, the AMI and Stroke mortality rates are overall not statistically different from the one observed in the control group providing evidence of the hospital ability to manage -with the implementation of a double track organization- and simultaneously delivery high quality cares to both Covid and no-Covid patients. The obtained results provided by RDD and DRD models are robust also when we account for seasonality and unobserved factors.

ROSSI Camillo;  BERTA Paolo;  CURELLO Salvatore;  LOVAGLIO Piergiorgio;  MAGONI Mauro;  METRA Marco;  ROCCARO Aldo Maria;  VERZILLO Stefano;  VITTADINI Giorgio; 

2021-10-18

PUBLIC LIBRARY SCIENCE

JRC124425

1932-6203 (online),   

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257910,    https://publications.jrc.ec.europa.eu/repository/handle/JRC124425,