Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis

Abstract

Aims The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. Methods and results A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20–2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43–3.10) vs. 1.21 (95% CI 1.07–1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). Conclusions In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.

Cardiovascular Mortality During the COVID-19 Pandemics in a Large Brazilian City: A Comprehensive Analysis

“…First, studies revealed a reduction in hospitalizations, procedures, and/or consultations for CVD in high [26][27][28][29][30], and low-and middle income countries (LMIC) [31,32], then an increase in out-ofhospital deaths [33,34]. Moreover, a rise in the proportion of in-hospital mortality for CVD was reported, being this effect larger where greater decline in admission rates occurred, suggesting hospitalizations of sicker patients or delivery of worse quality of care, corroborating our findings [35,36]. In parallel, other studies revealed that excess mortality in the pandemic period could not be explained exclusively by COVID-19 deaths, and excess CVD deaths was found in some countries, including Brazil, which is not surprising, knowing the beneficial effect of in-hospital timely treatment for the most lethal cardiovascular conditions, such as ACS [37][38][39].…”

The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System

“…People who were sick at the time were more likely to be admitted to the trials where admission rates fell the most. 18 The aim of this review is to look at how the Corona virus has played a role in the development of several diseases that affect the heart and blood flow. Some of these diseases are myocardial damage, the effects of COVID-19 on people with congenital heart disease, heart failure, arrhythmias, microvascular angiopathy, and cardiac damage.…”

Cardiovascular Mortality during the COVID-19 Pandemics in a Large Brazilian City: a Comprehensive Analysis

“…33,34 Moreover, a rise in the proportion of inhospital mortality for CVD was reported, being this effect larger where greater decline in admission rates occurred, suggesting hospitalizations of sicker patients or delivery of worse quality of care, corroborating our findings. 35,36 In parallel, other studies revealed that excess mortality in the pandemic period could not be explained exclusively by COVID-19 deaths, and excess CVD deaths was found in some countries, including Brazil, which is not surprising, knowing the beneficial effect of in-hospital timely treatment for the most lethal cardiovascular conditions, such as ACS. [37][38][39] However, even though the effect of the pandemics in CVD deaths had already been investigated in six Brazilian capital cities, the findings could not be extended to Belo Horizonte due to the heterogeneity of the pandemics in Brazil.…”