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

Abstract

Objective: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects.

Methods: Retrospective 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.

Results: Across 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.

Conclusions: Substantial 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.

Keywords: aortic and arterial disease; epidemiology; global health care delivery; health care delivery; heart disease.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Overall hospital activity (admissions, ED attendances and COVID-19 admissions) between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019. Lines describe the mean hospital activities in 2019–2020 (solid) and 2018–2019 (dotted). Shading represents 95% CI of the respective hospital activity. The first case of COVID-19 was on 31 January 2020 and lockdown started on 23 March 2020. ED, emergency department.

Figure 2

Percentage change compared with the previous year in ED attendances and hospital admissions for individual hospitals. Eight hospitals provided data on hospital admissions and five hospitals (A, B, C, D and H) also provided data on ED attendances. Hospital G did not provide these hospital statistics and is not shown. ED, emergency department.

Figure 3

% change compared with the previous year in ED attendance, hospital admissions and procedures/treatments for cardiac, cerebrovascular and other vascular conditions. Cardiac ED attendances are those with an ED diagnosis code for cardiac conditions; cardiac admissions include those with acute coronary syndrome or heart failure; cardiac procedures/treatments include percutaneous coronary intervention, cardiac pacemaker or resynchronisation and coronary artery bypass graft; cerebrovascular ED attendances are those with an ED diagnosis code for cerebrovascular conditions; cerebrovascular admissions include those with acute stroke (ischaemic, intracerebral haemorrhage or subarachnoid haemorrhage) or transient ischaemic attack; cerebrovascular procedures/treatments include stroke thrombolysis, thrombectomy, carotid endarterectomy/stenting or cerebral aneurysm coiling; other vascular ED attendances are those with an ED diagnosis code for other vascular conditions; other vascular admissions include those with aortic aneurysms, DVT, PE or peripheral arterial disease; other vascular procedures include aortic aneurysm repair, limb revascularisation, bypass or amputation and peripheral angioplasty. Horizontal brown line indicates 0%; vertical green dotted line indicates first confirmed COVID-19 case on 31 January 2020; vertical purple dotted line indicates lockdown date on 23 March 2020. Shading represents 95% CIs of % change. DVT, deep vein thrombosis; ED, emergency department; PE, pulmonary embolism.

Figure 4

Relative reductions in hospital activities during the COVID-19 pandemic. Relative reduction (RR) comparing phase 2 (between first case and lockdown) and phase 3 (after lockdown) to phase 1 (before first case). ACS, acute coronary syndrome; CABG, coronary artery bypass graft; DVT, deep vein thrombosis; ED, emergency department; PCI, percutaneous coronary interventions; PE, pulmonary embolus; TIA, transient ischaemic attack.