Abstract
BACKGROUND AND AIMS: The COVID-19 pandemic strained healthcare systems, affecting management of coronary heart disease (CHD). This study aims to assess the association between the COVID-19 pandemic and in-hospital case fatality rates, emergency department visits, and hospital admissions for CHD in Mexico. METHODS: We conducted an ecological study utilizing data from the Mexican Ministry of Health, spanning January 2018 to December 2021. CHD was defined using ICD-10 codes I20-I25. We analyzed monthly and annual trends in CHD-related emergency visits, hospital admissions, and in-hospital case fatality rates (CFR), reporting results with 95% confidence intervals. The Kruskal-Wallis test assessed statistical significance. Segmented log-linear regression models, with a fixed breakpoint in March 2020, were applied to monthly rates to estimate pre- and post-break trends (Annual Percent Change, APC) and immediate level changes, using Newey-West standard errors. RESULTS: CHD emergency visits decreased by 9.8% in March 2020% and 60.8% in May 2020, with annual declines of 36.5% in 2020% and 32.3% in 2021 compared to pre-pandemic levels. Hospital admissions fell by 31.6% in 2020% and 19.4% in 2021. Meanwhile, in-hospital CFR rose from 8.6% before the pandemic to 12.6% in 2020% and 11.8% in 2021. A similar trend was observed in hospital discharges, where CFR increased from 13.75% pre-pandemic to 16.63% in 2020% and 16.15% in 2021. Although hospital mortality was higher among women, men experienced greater reductions in emergency visits and larger relative increases in mortality. Segmented regression revealed an immediate drop of -54.6% in emergency visits and -50.8% in discharges, followed by annual post-break increases of 2.09% and 2.88%, respectively. CONCLUSION: The COVID-19 pandemic in Mexico was associated with a decline in CHD hospital admissions alongside a significant rise in in-hospital CFR, with segmented regression showing partial recovery following the initial drop, underscoring the need to strengthen healthcare resilience.