Older adults and major cardiovascular events requiring emergency department consultation during the 1st wave of the COVID-19 pandemic: results from the EDEN-4 Study.

Emergency department visits by older adults dropped substantially during the first COVID-19 wave compared to the pre-COVID period.

• Total ED visits fell by 61.8% during the COVID period (from 25,557 to 9,770).
• The study analyzed patients aged ≥65 years attending 52 Spanish EDs during one week of the 1st COVID-19 wave (April 1–7, 2020) versus the same week in the prior year (March 30–April 5, 2019).

The incidence of ED visits for major acute cardiovascular events (MACE) among older adults decreased by 39.1% during the COVID period.

• 297 patients attended the ED for MACE during the COVID period (incidence rate 131.2 per 100,000 persons per year).
• 488 patients attended during the pre-COVID period (incidence rate 215.6 per 100,000 persons per year).
• Incidence reduction was 39.1% (95% CI, 29.7–47.3).

The reduction in ED visits for cardiac events was significantly greater than for cerebrovascular events during the COVID period.

• Cardiac event incidence rates were 43.3 (COVID) vs. 99.9 (pre-COVID) per 100,000 persons per year, representing a reduction of 56.6% (95% CI, 45.0–65.8).
• Cerebrovascular event incidence rates were 88.8 (COVID) vs. 116.7 (pre-COVID), representing a reduction of 23.9% (95% CI, 8.5–36.6).
• The difference in reduction between cardiac and cerebrovascular events was statistically significant (P < .001).

Patients presenting with MACE during the COVID period had lower comorbidity than those presenting in the pre-COVID period.

• Lower comorbidity was observed among MACE patients attending during the COVID period compared to the pre-COVID period.
• This finding was noted as part of the patient profile comparison across periods.

MACE patients presenting during the COVID period had significantly fewer ICU admissions compared to the pre-COVID period.

• ICU admission odds ratio was 0.338 (95% CI, 0.149–0.764) for the COVID period versus the pre-COVID period.
• This result was adjusted for patient characteristics.

MACE patients presenting during the COVID period had significantly more ED revisits compared to the pre-COVID period.

• ED revisit odds ratio was 1.764 (95% CI, 1.116–2.790) for the COVID period versus the pre-COVID period.
• This result was adjusted for patient characteristics.

There was no statistically significant difference in 30-day all-cause mortality between MACE patients presenting during the COVID period versus the pre-COVID period.

• 30-day all-cause mortality hazard ratio was 1.474 (95% CI, 0.971–2.239) for the COVID period versus the pre-COVID period.
• The confidence interval crossed 1.0, indicating no statistically significant difference.
• Mortality was adjusted for patient characteristics.