The Impact of the COVID-19 Pandemic on Acute Coronary Syndrome Hospitalizations and Identifying Implications for Future Public Health Response Measures to PandemicsHerbert, 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 (Unpublished)
AbstractThe 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. Share
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