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Early during the COVID-19 pandemic, marked declines in patients presenting with acute cardiovascular conditions were observed,1,2 whereas mortality attributed to cardiovascular causes increased.3 This raised concerns that patient reluctance to seek emergency care contributed to preventable complications and excess deaths, and public health campaigns sought to reassure patients that hospitals were safe and to encourage seeking care when needed. As COVID-19 resurged in late 2020, rates of infections, hospitalizations, and deaths exceeded those of previous surges. Many countries reimplemented lockdowns, and recent UK data indicate that presentations for emergent cardiovascular conditions again declined.4 We evaluated changes in rates of acute myocardial infarction (AMI) hospitalizations and suspected ischemic stroke as measures of patient willingness to seek emergency care during the most recent COVID-19 surges in the US.
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Corresponding Author: Matthew D. Solomon, MD, PhD, Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611 (firstname.lastname@example.org).
Accepted for Publication: May 10, 2021.
Published Online: June 2, 2021. doi:10.1001/jama.2021.8414
Author Contributions: Dr Solomon had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Solomon, Nguyen-Huynh, Rana, Klingman, Go.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Solomon, Nguyen-Huynh, Leong, Go.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Solomon, Leong, Alexander.
Obtained funding: Solomon.
Administrative, technical, or material support: Solomon, Nguyen-Huynh, Leong.
Supervision: Solomon, Nguyen-Huynh, Go.
Conflict of Interest Disclosures: Dr Solomon reported receiving grants from The Permanente Medical Group and the Kaiser Permanente Garfield Memorial Fund during the conduct of the study. Dr Nguyen-Huynh reported receiving grants from The Permanente Medical Group and the Kaiser Permanente Garfield Memorial Fund during the conduct of the study. Dr Go reported receiving grants from The Permanente Medical Group and the Garfield Memorial Fund during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was sponsored by grants from the Kaiser Permanente Garfield Memorial Fund and The Permanente Medical Group Delivery Sciences and Applied Research Program.
Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Additional Contributions: We acknowledge additional persons who contributed to the work, including Edward J. McNulty, MD (Department of Cardiology, Kaiser Permanente Northern California), for contributions to concept and design and analysis and interpretation of the data, and Sue Hee Sung, MPH (Division of Research, Kaiser Permanente Northern California), for contributions to supervision and administrative, technical, and material support. No one received financial compensation for their contributions.
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