Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

Abstract

Background: Cardiovascular diseases(CVD) increase mortality risk from coronavirus infection(COVID-19), but there are concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both direct, through infection, and indirect, through changes in healthcare. Methods: We used population-based electronic health records from 3,862,012 individuals in England to estimate pre- and post-COVID-19 mortality risk(direct effect) for people with incident and prevalent CVD. We incorporated: (i)pre-COVID-19 risk by age, sex and comorbidities, (ii)estimated population COVID-19 prevalence, and (iii)estimated relative impact of COVID-19 on mortality(relative risk, RR: 1.5, 2.0 and 3.0). For indirect effects, we analysed weekly mortality and emergency department data for England/Wales and monthly hospital data from England(n=2), China(n=5) and Italy(n=1) for CVD referral, diagnosis and treatment until 1 May 2020. Findings: CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy and England during the pandemic. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown, and is still reduced in Italy and England. Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous(peak RR 1.4). For total CVD(incident and prevalent), at 10% population COVID-19 rate, we estimated direct impact of 31,205 and 62,410 excess deaths in England at RR 1.5 and 2.0 respectively, and indirect effect of 49932 to 99865 excess deaths. Interpretation: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the COVID-19 pandemic.

Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK

“…29 Where reported, recovery of activity has generally been slow; for example, in hospitals in China, CVD activity remained below pre-COVID-19 levels for 2–3 months, even after easing lockdown. 10 To our knowledge, the present report is the first UK study to have recorded overall and cardiovascular hospital activity over a long enough period since lockdown to show the beginning of recovery in some measures and is the only study we are aware of to provide analyses of these via an online tool designed to include data from additional hospitals and regular updates over the months ahead.…”

“… 8 9 In the UK, studies have reported reductions in activity across CVDs. 10 11 Moreover, official national statistics show an excess of non-COVID-19 and CVD deaths, 12 13 as well as a reduction in emergency department (ED) attendances for cardiac presentations. 14…”

Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study

“…Fourth, we only have access to empirical cancer service change data from eight hospitals in the UK. While the data may be a representative sample of the UK population, and patterns of decline in service change is corroborated in another study, 42 more widespread access to other trusts may be beneficial to ascertain national and regional effects.…”

Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study

“… 4 Moreover, as countries plan strategies to exit or scale down lockdown, policies to tackle COVID-19 may have unintended consequences on health care and outcomes for non-COVID-19 diseases, which we reported for cancer and cardiovascular diseases (CVDs). 5 , 6 …”