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

Abstract

ObjectiveTo monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects.MethodsRetrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018–2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends.ResultsAcross nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%–58.6%) and 52.9% (52.2%–53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1–2 weeks before lockdown and fell by 31%–88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93–0.95; total hospital admissions RR 0.96, 0.95–0.97) and after lockdown (attendances RR 0.63, 0.62–0.64; admissions RR 0.59, 0.57–0.60). There was limited recovery towards usual levels of some activities from mid-April 2020.ConclusionsSubstantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

The impact of the coronavirus disease 2019 epidemic on notifiable infectious diseases in Taiwan: A database analysis

“…Regarding stroke, access to acute stroke diagnostics and time-dependent therapies was limited or delayed owing to reduced emergency service capacities, and a marked reduction in the number of patients admitted with transient ischemic attack and/or stroke was noted in the emergency departments of three European countries (Italy, France, and Germany)[ 5 ]. Another study in the United Kingdom showed similar findings, whereby substantial reductions in the activities of patients with cardiac, cerebrovascular, and other vascular complications started 1–2 weeks before the lockdown and dropped to 31–88% following the lockdown [ 6 ]. All of these may be attributed to a major burden of the collateral effects of the COVID-19 pandemic.…”

Cardiovascular health and COVID-19: time to reinvent our systems and rethink our research priorities

“…4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals. 5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand: the restructuring of hospital services to cope with an influx of COVID-19 cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.…”

“…Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during COVID-19. 5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home). 4 They also found that healthcare system collapse in more socioeconomically deprived states was associated with increased acute coronary syndrome and stroke deaths in these states, independent of the uptick in deaths at home.…”

“…Ball et al found that emergency department visits and percutaneous coronary intervention procedure rates in UK hospitals had partially rebounded by the end of May 2020. 5 Assuming the top objective is to maximise health, emergency cardiac care and interventional services should be brought back online before phasing in other semielective vascular procedures (even if the latter provide substantial revenues to hospitals). Critically, more must be done to encourage patients with acute cardiac or neurological symptoms to seek care even in the face of potential COVID-19 exposure.…”

Heartbeat: cardiovascular health in the time of COVID-19

“…Pathophysiological model of serial AS progression ('aortic stenosis cascade', in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1 South Korean PCSK9 inhibitors (NCT03051360); 2 EAVaLL: early aortic valve lipoprotein(a) lowering (NCT02109614); 3 SALTIRE II: study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026); 4 BASIK2: bicuspid aortic valve stenosis and the effect of vitamin K 2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525); 5 EvoLVeD: early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143); 6 Early TAVR: evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose; 18F-NaF, 18-sodium fluoride; AS, aortic stenosis; AVC, aortic valve calcification; PET, positron emission tomography; PCSK9, proprotein convertase subtilisin/kexin type 9; TAVR, transcatheter aortic valve replacement.…”