Lockdown in Denmark Linked to Drop in New AF Diagnoses

By Anne Harding

July 10, 2020

NEW YORK (Reuters Health) - The incidence of new-onset atrial fibrillation (AF) fell by nearly half during the first three weeks of Denmark's COVID-19 lockdown, new findings in the European Heart Journal show.

During quarantine, patients were told to seek medical care only if urgent and always call ahead, which some AF patients may have misinterpreted to mean that they should overlook mild to moderate symptoms and not seek medical care, Dr. Anders Holt of Herlev and Gentofte University Hospital in Copenhagen told Reuters Health in an email.

"Since untreated AF carries a risk of stroke in particular, this could be associated with collateral damage alongside the COVID19 pandemic. In my opinion, physicians have a responsibility to re-establish the easy access to a consultation with a physician--even when the patient considers the symptoms mild," Dr. Holt said.

He and his colleagues analyzed Danish registry data on all adults diagnosed with new-onset AF in the first months of 2019 and 2020, and compared AF incidence, patient characteristics and outcomes for the lockdown period of March 12-April 1, 2020, to the same three-week period in 2019.

The AF incidence rate ratios for the first, second and third weeks of lockdown compared to the previous year were 0.66, 0.53 and 0.41, respectively. Total number of diagnoses over the three-week period fell from 1,053 in 2019 to 562 in 2020, a 47% drop.

AF patients diagnosed in 2020 were younger, had lower average CHA2DS2-VASc scores, and were more likely to have a history of cancer, heart failure or vascular disease, the authors found. Thirty patients (5.3%) had ischemic stroke and 15 died (2.7%), versus 45 (4.3%) and 14 (1.3%) of the patients diagnosed in 2019. Adjusted odds ratio for ischemic stroke or all-cause death was 1.41 for patients diagnosed during the lockdown compared to those diagnosed in 2019.

"There could be other explanations to the drop in new AF cases (1) the drop is 'real' due to social isolation, less infectious diseases transmission, less stress etc. (2) We have not accounted for patients being diagnosed by their GP and treated relevantly," Dr. Holt said.

"I think the interesting question is how we prepare for and handle a second wave of COVID19 and probable new lock-downs--which seems to have already started in some big cities around the world," he added.

"Patients should always have the means and encouragement to consult with a physician if they feel something is off--phone or video-call would have to do, during a pandemic," Dr. Holt said. "Regarding AF specifically, it should be possible to establish some kind of screening procedure with minimal hospital and personal contact to make sure that patients are diagnosed and treated accordingly."

Dr. Carina Blomstrom-Lundqvist of Uppsala University in Sweden wrote an editorial published a few days after the study appeared online.

"I think we have learned from the Danish study and other studies that patients in general and particularly those with previously unknown AF do not seek health care unless they have other disease states that result in more severe symptoms," she told Reuters Health in an email.

"We must provide the same high quality health care to patients who are not part of a pandemic," Dr. Blomstrom-Lundqvist added. "We must make sure not to give the wrong message to the community and to patients that they should refrain from seeking medical care unless urgently needed. They can themselves not judge when it is urgently needed. Vague symptoms may be signs of a disease that may need prompt treatment."

SOURCE: https://bit.ly/3feXxgz and https://bit.ly/2CeGkFB European Heart Journal, online June 24 and July 2, 2020.