Impacto da pandemia por COVID-19 no perfil de pacientes da unidade de terapia intensiva coronariana de um hospital público terciário

Abstract

Introduction: The COVID-19 pandemic, which began in 2019, has overwhelmed healthcare systems globally, significantly impacting Intensive Care Units (ICUs), including Coronary Care Units (CCUs). This study analyzes the impact of the pandemic on the patient profile and performance of the CCU at the Regional Hospital of Presidente Prudente (HR), a tertiary public hospital of reference in the western region of São Paulo state. Objectives: To analyze the profile of patients admitted to the HR CCU before, during, and after the COVID-19 pandemic, evaluating changes concerning severity, unit performance indicators, and clinical outcomes. Materials and Methods: This is a retrospective observational study using data from patients admitted to the HR CCU between June 2019 and December 2023. The study was divided into three periods: pre-pandemic (June 2019 to June 2020), pandemic (July 2020 to December 2022), and post-pandemic (January 2023 to December 2023). Demographic, clinical, and unit performance indicator data, such as occupancy rate, average length of stay, bed turnover, and mortality, were collected. Binary logistic regression was performed to assess mortality in each period. Results: A cohort of 3,657 patients was assessed, comprising 919 in the pre-pandemic group, 1,884 in the pandemic group, and 854 in the post-pandemic group. During the pandemic, there was a reduction in the average monthly admissions to the CCU, with pre-pandemic admissions averaging 70.7, pandemic admissions at 62.8, and post-pandemic admissions at 71.2. There was a notable decrease in admissions due to cardiovascular reasons (86.2% pre-pandemic versus 73.6% during the pandemic, p<0.05). Additionally, an increase in the severity of admitted patients was observed, as indicated by the SAPS 3 score (pre-pandemic 44.2, pandemic 48.3, and post-pandemic 45.9; p=0.001). The mortality rate remained consistent throughout the pandemic period. Logistic regression analysis revealed higher mortality rates in the CCU among older patients (OR 1.03; 95% CI: 1.02-1.04), females (OR 1.40; 95% CI: 1.08-1.82), those requiring assistance for daily activities, and those who were bedridden (OR 1.50; 95% CI: 1.08-2.08 and OR 2.69; 95% CI: 1.70-4.25, respectively), as well as patients without a prior acute myocardial infarction (AMI) (OR 1.86; 95% CI: 1.25-2.78). Conclusion: We concluded that the COVID-19 pandemic altered the profile of the CCU. A decrease in cardiovascular admissions was observed during the pandemic period, along with an increase in all-cause hospital mortality among patients post-discharge from the CCU during and after the pandemic. However, there was no observed increase in mortality within the CCU itself.