In the United States, efforts to control the coronavirus disease (COVID)-19 pandemic brought sweeping social change, with stay-at-home orders and physical distancing mandates in 43 of 50 states by April 2020. Although these public health measures were intended to curb the spread of COVID-19, their impact on individuals with other health conditions was largely unknown. Initial anecdotal reports described precipitous decreases in emergency department (ED) visits for acute cardiovascular outcomes and were replicated by the results of several larger observational analyses. However, these studies relied primarily on data from select health systems or medical groups and few reported on the impact of the pandemic past May 2020. Now, more than a year since the US confirmed its first case of COVID-19, our objective is to provide an understanding of the pandemic's longer-term impact on ED utilization for acute cardiovascular disease. We hypothesized that (1) acute myocardial infarction (AMI) and stroke/transient ischemic attack (TIA)-related ED visits in North Carolina (NC) decreased substantially after a statewide stay-at-home order was announced on March 27, 2020 and that (2) ED visits decreased considerably over the course of 2020 in comparison to 2019
