@article{2997313,
    title = "Persistent decline of hospitalizations for acute stroke and acute coronary syndrome during the second wave of the COVID-19 pandemic in Greece: collateral damage unaffected",
    author = "Katsouras, C. and Tsivgoulis, G. and Papafaklis, M. and Karapanayiotides, T. and Alexopoulos, D. and Ntais, E. and Papagiannopoulou, G. and Koutroulou, I. and Ziakas, A. and Sianos, G. and Kouparanis, A. and Trivilou, P. and Ballas, C. and Samara, I. and Kosmidou, M. and Palaiodimou, L. and Grigoriadis, N. and Michalis, L.K. and Giannopoulos, S.",
    journal = "Therapeutic Advances in Neurological Disorders",
    year = "2021",
    volume = "14",
    publisher = "SAGE Publications Ltd",
    issn = "1756-2856, 1756-2864",
    doi = "10.1177/17562864211029540",
    keywords = "acute coronary syndrome;  adult;  angina pectoris;  Article;  cardiovascular disease;  chronic kidney failure;  controlled study;  coronary artery bypass graft;  coronavirus disease 2019;  diabetes mellitus;  female;  heart ejection fraction;  heart infarction;  hospital admission;  hospitalization;  human;  hypercholesterolemia;  hypertension;  incidence;  intensive care unit;  interview;  ischemic stroke;  lockdown;  major clinical study;  middle aged;  National Institutes of Health Stroke Scale;  non ST segment elevation myocardial infarction;  observational study;  pandemic;  percutaneous coronary intervention;  peripheral occlusive artery disease;  smoking;  ST segment elevation myocardial infarction;  tertiary care center",
    abstract = "Background: An alarming cerebro/cardiovascular collateral damage, reflected by a decline in admissions for acute stroke (AS) and acute coronary syndrome (ACS), was observed during the initial phase of the COVID-19 pandemic, thereby leading to a re-design of public campaigns. However, there are limited data regarding the AS and ACS hospitalization rates during the second wave of the pandemic, which was followed by re-imposition of lockdowns. Methods: We calculated the rate of AS and ACS hospitalizations from three representative tertiary care hospitals in Greece during a 2-month period (November–December 2020) of the second wave of the COVID-19 pandemic compared with the corresponding control period in 2019 from three representative tertiary care hospitals in Greece. This was a follow-up study with identical design to our previous report evaluating AS and ACS hospitalizations during the first wave of the pandemic (March–April 2020). Results: Compared with 2019, there was a 34% relative reduction of AS hospitalizations [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.48–0.92, p = 0.013] and 33% relative reduction of ACS hospitalizations (IRR: 0.67, 95% CI: 0.54–0.83, p < 0.001) during the second wave of the COVID-19 pandemic. The relative reduction was smaller and did not reach the level of statistical significance for the respective syndromes (haemorrhagic stroke: IRR 0.87, 95% CI: 0.41–1.82, p = 0.71; ST-elevation myocardial infarction: IRR 0.81, 95% CI: 0.57–1.14, p = 0.22). Conclusion: AS and ACS hospitalizations were persistently reduced during the second wave of the COVID-19 pandemic compared with 2019 in Greece. This decline was similar to the observations during the first wave despite the large differences in the epidemiological COVID-19 burden. Lockdowns, a common characteristic in both waves, appear to have a detrimental indirect impact on cerebro/cardiovascular diseases in the general population. © The Author(s), 2021."
}