Journal
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
Volume 28, Issue 14, Pages 1599-1608Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurjpc/zwaa155
Keywords
Cardiovascular disease; Coronavirus-2019; Public health; Global health; Health policy
Categories
Funding
- NIHR
- UKRI
- British Medical Association
- Astra Zeneca
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre
- Health Data Research UK (HDR-UK) - UK Medical Research Council [LOND1]
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Department of Health and Social Care (England)
- Public Health Agency (Northern Ireland)
- British Heart Foundation
- Wellcome Trust
- BigData@Heart Consortium -Innovative Medicines Initiative-2 joint undertaking [116074]
- EU
- European Federation of Pharmaceutical Industries and Associations
- British Heart Foundation [CH/1999001/11735]
- NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London [IS-BRC-1215-20006]
- Foundation Leducq
- NIHR University College London Hospitals Biomedical Research Centre
- Health Data Research UK Grant [MR/S004149/1]
- Industrial Strategy Challenge Grant [MC_PC_18029]
- Wellcome Institutional Translation Partnership Award [PIII054]
- Wellcome Trust Investigator in Science award [207511/Z/17/Z]
- NIHR [CL-2016-17-001]
- Medical Research Council
- NIHR ARC East Midlands
- Chief Scientist Office of the Scottish Government Health and Social Care Directorates
- Health and Social Care Research and Development Division (Welsh Government)
- National Institutes of Health Research (NIHR) [IS-BRC-1215-20006] Funding Source: National Institutes of Health Research (NIHR)
- Wellcome Trust [207511/Z/17/Z] Funding Source: Wellcome Trust
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The study estimated excess mortality risk of cardiovascular diseases during the COVID-19 pandemic, including direct through infection and indirect through changes in healthcare. It found that cardiovascular service activity decreased by 60-100% in eight hospitals across China, Italy, and England, and that the indirect effects on cardiovascular diseases may be delayed rather than contemporaneous.
Aims Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also 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 and results We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n=2), Italy (n=1), and China (n=5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0). Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths. Conclusion Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.
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