DOI kodi: 10.52340/ekonomisti.2026.02.19

Extended Summary

The COVID-19 pandemic placed exceptional pressure on health systems, including in Georgia, and made continuity of care for chronic non-communicable diseases more difficult to maintain. This summary compares ischemic heart disease hospitalizations in Georgia during 2017–2019 and 2020–2022. The analysis shows a clear shift: angina pectoris admissions declined, while acute myocardial infarction cases increased, suggesting later and more severe hospital presentation among some patients.

Methodology and Diagnostic Categorization
The study used aggregated inpatient data classified by ICD-10 codes. Cases were grouped into three cohorts: angina pectoris (I20), acute myocardial infarction (I21), and other ischemic or chest pain-related diagnoses (I22, I23, I24, I25, R07). Absolute patient numbers and percentage shares were compared across the two periods to assess changes in the clinical profile of hospitalized IHD patients.

Statistical Findings and Comparative Data Analysis
The data show (See table 1) a notable change in IHD-related hospitalizations. In 2017–2019, angina pectoris accounted for the majority of admissions. In 2020–2022, angina admissions declined, while myocardial infarction admissions increased. This pattern should be interpreted cautiously, as it may reflect reduced opportunities for timely diagnosis, outpatient follow-up, and early intervention during the pandemic period rather than a decline in cardiovascular disease burden.

Table 1. Changes in Ischemic Heart Disease Hospitalizations in Georgia, 2017–2022 

The simultaneous decrease in angina hospitalizations and increase in myocardial infarctions suggests a possible shift from earlier, planned, or lower-acuity care toward later and more urgent presentation. In managerial terms, the data point to deterioration in the clinical profile of hospitalized cardiovascular patients rather than disappearance of demand for cardiovascular care.

Multifactorial Analysis: Key Clinical and Social Drivers

The observed shift from angina-related admissions toward more acute myocardial infarction cases was likely multifactorial. Four interrelated drivers are particularly relevant:

1. Medical fear and delayed care-seeking: Fear of infection in clinical settings may have discouraged patients with chest pain or warning symptoms from seeking timely outpatient consultation, diagnostic testing, or planned care.
2. Direct cardiovascular effects of SARS-CoV-2: COVID-19 may contribute to inflammation, endothelial dysfunction, platelet activation, and a prothrombotic state, increasing the risk of thrombosis and acute coronary events in vulnerable patients.
3. Re-profiling of hospital capacity: The temporary conversion of many facilities into COVID-19 centers reduced availability for non-COVID cardiology care and placed pressure on referral and transfer pathways.
4. Psychosocial stress and lifestyle changes: Lockdowns, reduced mobility, economic insecurity, physical inactivity, and stress-related behavioral changes may have worsened cardiovascular risk profiles and chronic disease control.

Health Management Conclusions and Policy Implications

The reduction in angina hospitalizations in Georgia during 2020–2022 should be interpreted cautiously. It may not indicate a decline in cardiovascular morbidity, but rather reduced opportunities for early diagnosis, outpatient monitoring, and timely intervention during a period of exceptional system pressure. At the same time, the increase in myocardial infarction admissions suggests that some patients may have reached hospital care later and in more severe condition.

From a health system perspective, this pattern has implications for both patient outcomes and resource use, as cases that might have been managed through routine outpatient or planned cardiology care may have required urgent, resource-intensive interventions such as PCI, stenting, or coronary artery bypass grafting. Future pandemic preparedness should therefore protect continuity of essential non-communicable disease services, including cardiac pathways, emergency transport, outpatient diagnostics, and chronic disease follow-up alongside infectious disease management.

References 

1. World Health Organization. Maintaining essential health services: operational guidance for the COVID-19 context. Geneva: WHO, 2020.

2. Nishiga M., Wang D.W., Han Y., Lewis D.B., Wu J.C. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nature Reviews Cardiology, 2020;17:543–558.

3. Bonaventura A. et al. Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19. Nature Reviews Immunology, 2021;21:319–329.

4. Xie Y., Xu E., Bowe B., Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nature Medicine, 2022;28:583–590.

5. Data basis: National Center for Disease Control and Public Health, Georgia, aggregated inpatient IHD statistics for Georgia,  2017–2022, grouped by ICD-10 categories I20, I21, I22–I25 and R07.