Change in incidence of cardiovascular diseases during the covid-19 pandemic and vaccination campaign: data from the nationwide French hospital discharge database

ImportanceThe covid-19 pandemic induced a severe disruption in hospital activity. Cardiovascular illnesses represent a major health burden in industrialised countries and are second in terms of hospital bed occupancy in France. Considering the resources mobilized and the public health issue involved, it is necessary to study the impact of the pandemic on their incidences. ObjectiveTo monitor changes in the incidence of cardiovascular diseases during years 2020 and 2021 compared to 2019. DesignNationwide population-based cohort study. SettingFrench hospital discharge database between January 1 and October 30 in 2019, 2020 and 2021. ParticipantsNew patients hospitalized for vascular disease in Metropolitan France. A patient was considered as incident for a morbidity if not present in the database in the previous two years with the morbidity as the primary reason for admission. Main outcome measuresStandardized hospitalization incidence difference and relative risk of hospitalization for a series of targeted vascular diseases from January 1 to October 31 for 2021 versus 2019. Demographic data from 2019 were used for the standardization of patient counts by 10-year age strata for each morbidity and year. ResultsWhile the relative risk of hospitalization in 2021 versus 2019 decreased for almost all diseases, an increase in relative risk was observed for myocarditis (28.0%) and pulmonary embolisms (10.0%). In 2020, the relative risk of hospitalization versus 2019 also decreased for almost all diseases but remained stable for myocarditis and increased by 4.0% for pulmonary embolisms. In 2021, the difference in myocarditis coincided with the vaccination campaign in young individuals. The increase in pulmonary embolism occurred predominantly in older women, with a weak but still noticeable coincidence with the vaccination campaign. ConclusionsThe deficit in care for patients with acute atherothrombotic manifestations in 2021 and 2020 shows a failure by the French healthcare system to rectify the deficiencies of 2020. The risk excess for pulmonary embolism cannot be entirely explained by covid-19 or by vaccine-induced immune thrombotic thrombocytopenia. This warrants investigating the risk/efficacy ratio of a temporary thromboprophylaxis in individuals at risk before vaccine.