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

2020; Cold Spring Harbor Laboratory; Linguagem: Inglês

10.1101/2020.06.10.20127175

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

COVID-19 Clinical Research Studies

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. Funding NIHR, HDR UK, Astra Zeneca