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The Impact of the COVID-19 Pandemic on Acute Coronary Syndrome Hospitalizations and Identifying Implications for Future Public Health Response Measures to Pandemics

Herbert, Brandon (2023) The Impact of the COVID-19 Pandemic on Acute Coronary Syndrome Hospitalizations and Identifying Implications for Future Public Health Response Measures to Pandemics. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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The COVID-19 pandemic exerted a profound influence on population health, healthcare systems and treatment and prevention efforts. This dissertation includes three manuscripts related to acute coronary syndrome (ACS). The first evaluates the impact of the COVID-19 pandemic on trends of ACS hospitalizations, all-cause deaths and ischemic heart disease deaths in Allegheny County, Pennsylvania. The results of this analysis suggest that the COVID-19 pandemic had minimal effect on the longitudinal declining trend of acute myocardial infarction hospitalizations and ischemic heart disease deaths in Allegheny County.

The second manuscript extends this work by assessing the association between ACS rates and statewide stay-at-home policies. This analysis included a much larger, claims-based dataset that included patients evaluated across the U.S. We identified that statewide stay-at-home orders were associated with a 14.9% decline in age-adjusted ACS rates controlling for state-specific COVID-19 rates. There was heterogeneity in the association between stay-at-home policies and ACS rates by race/ethnicity, suggesting that there may have been differential access to medical care or differences in exposure to protective risk factors of ACS, particularly for people of Hispanic ethnicity.

The third manuscript estimates the risk of ACS among those with a diagnosis of COVID-19 in the same claims-based dataset using a matched cohort design. In fully adjusted models, cases were 25.1-fold more likely to have an ACS event in the first three days following a COVID-19 diagnosis. From days 4 to 90, the likelihood of ACS declined steeply among those with a COVID-19 diagnosis but remained elevated as late as days 61 to 90. These findings provide further evidence that COVID-19 is a significant risk factor for ACS, even after the acute phase of infection.

This body of work offers unique insight into the impact the COVID-19 pandemic had on individuals with ACS. These findings have important implications for future public health response strategies to pandemics, clinical management of ACS with co-occurring COVID-19, and the development of targeted interventions to mitigate cardiovascular morbidity and mortality during pandemics. Further research is needed to understand underlying mechanisms and address the observed disparities in ACS rates among different racial/ethnic groups.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Herbert, Brandonbmh81@pitt.edubmh810000-0003-3857-7422
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrooks, Mariambrooks@pitt.edumbrooks
Committee CoChairMagnani, Jaredmagnanij@pitt.edumagnanij
Committee MemberSekikawa, Akiraakira@pitt.eduakira
Committee MemberEl Khoudary, Samarelkhoudarys@edc.pitt.eduelkhoudarys
Committee MemberHernandez,
Date: 29 August 2023
Date Type: Publication
Defense Date: 11 July 2023
Approval Date: 29 August 2023
Submission Date: 10 August 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 147
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: acute coronary syndrome, myocardial infarction, cardiovascular disease, COVID-19, stay-at-home orders, health disparities
Date Deposited: 29 Aug 2023 17:58
Last Modified: 29 Aug 2023 17:58


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