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

Amitava Banerjee; Suliang Chen; Laura Pasea; Alvina G Lai; Michail Katsoulis; Spiros Denaxas; Vahe Nafilyan; Bryan Williams; Wai Keong Wong; Ameet Bakhai; Kamlesh Khunti; Deenan Pillay; Mahdad Noursadeghi; Honghan Wu; Nilesh Pareek; Daniel Bromage; Theresa A McDonagh; Jonathan Byrne; James T H Teo; Ajay M Shah; Ben Humberstone; Liang V Tang; Anoop S V Shah; Andrea Rubboli; Yutao Guo; Yu Hu; Cathie L M Sudlow; Gregory Y H Lip; Harry Hemingway

doi:10.1093/eurjpc/zwaa155

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

Eur J Prev Cardiol. 2021 Dec 20;28(14):1599-1609. doi: 10.1093/eurjpc/zwaa155.

Authors

Amitava Banerjee^{1

2

3

4}, Suliang Chen^{1

2}, Laura Pasea^{1

2}, Alvina G Lai^{1

2}, Michail Katsoulis^{1

2}, Spiros Denaxas^{1

2}, Vahe Nafilyan⁵, Bryan Williams^{4

6

7}, Wai Keong Wong^{1

4}, Ameet Bakhai⁸, Kamlesh Khunti⁹, Deenan Pillay¹⁰, Mahdad Noursadeghi^{4

10}, Honghan Wu^{1

2

11}, Nilesh Pareek¹², Daniel Bromage^{12

13}, Theresa A McDonagh^{12

13}, Jonathan Byrne¹², James T H Teo¹², Ajay M Shah^{12

13}, Ben Humberstone⁵, Liang V Tang¹⁴, Anoop S V Shah¹⁵, Andrea Rubboli¹⁶, Yutao Guo¹⁷, Yu Hu¹⁴, Cathie L M Sudlow^{2

18

19}, Gregory Y H Lip^{20

21

22}, Harry Hemingway^{1

2}

Affiliations

¹ Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA.
² Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE.
³ Department of Cardiology, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, UK, E1 1BB.
⁴ University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU.
⁵ Office for National Statistics. 1 Drummond Gate, Pimlico, London, UK, SW1V 2QQ.
⁶ Institute of Cardiovascular Science, University College London, London, UK, WC1E 6BT.
⁷ University College London Hospitals NIHR Biomedical Research Centre, Maple House, 1st Floor, 149 Tottenham Court Road, London, UK, W1T 7DN.
⁸ Department of Cardiology, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
⁹ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, UK, LE5 4PW.
¹⁰ Division of Infection and Immunity, UCL Cruciform Building, University College London, Gower Street, London, UK, WC1E 6BT.
¹¹ School of Computer and Software, Najing University of Information Science and Technology, Ningliu Road, Nanjing, Jiangsu Province, P.R.C. 210044, China.
¹² Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS.
¹³ Kings College London British Heart Foundation Centre, School of Cardiovascular Medicine & Sciences, London, Strand, London WC2R 2LS. UK.
¹⁴ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
¹⁵ Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent Edinburgh, UK. EH16 4TJ.
¹⁶ Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna. Italy.
¹⁷ PLA General Hospital, 28 Fuxing Road, Beijing, Haidian District, Beijing, China.
¹⁸ Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Road, Edinburgh BioQuarter City, Edinburgh, UK, EH16 4UX.
¹⁹ BHF Data Science Centre, Health Data Research, 215 Euston Road, London, UK, NW1 2BE.
²⁰ Liverpool Centre for Cardiovascular Science, University of Liverpool,William Henry Duncan Building, 6 W Derby Street, Liverpool, UK, L7 8TX.
²¹ Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, UK, L14 3PE.
²² Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus 9000, Aalborg, Denmark.

Abstract

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 2-3 months 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.

Keywords: Cardiovascular disease; Coronavirus-2019; Global health; Health policy; Public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Communicable Disease Control
Humans
Pandemics
SARS-CoV-2

Abstract

Publication types

MeSH terms

Grants and funding