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Healthcare delivery, economics and global health
Original research
Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK
  1. Simon Ball1,2,
  2. Amitava Banerjee3,4,5,
  3. Colin Berry6,7,
  4. Jonathan R Boyle8,9,
  5. Benjamin Bray10,
  6. William Bradlow11,
  7. Afzal Chaudhry12,
  8. Rikki Crawley13,
  9. John Danesh8,12,
  10. Alastair Denniston1,2,
  11. Florian Falter14,
  12. Jonine D Figueroa15,
  13. Christopher Hall16,
  14. Harry Hemingway3,5,
  15. Emily Jefferson17,18,
  16. Tom Johnson19,
  17. Graham King20,
  18. Kuan Ken Lee21,
  19. Paul McKean20,
  20. Suzanne Mason22,23,
  21. Nicholas L Mills15,18,24,
  22. Ewen Pearson17,18,
  23. Munir Pirmohamed22,25,
  24. Michael T C Poon15,26,
  25. Rouven Priedon27,
  26. Anoop Shah28,
  27. Reecha Sofat4,29,
  28. Jonathan A C Sterne30,
  29. Fiona E Strachan31,
  30. Cathie L M Sudlow15,18,27,
  31. Zsolt Szarka16,
  32. William Whiteley32,
  33. Michael Wyatt19
  34. CVD-COVID-UK Consortium
  1. 1 University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
  2. 2 Health Data Research UK Midlands, Birmingham, United Kingdom
  3. 3 Institute of Health Informatics, University College London, London, United Kingdom
  4. 4 University College London Hospitals NHS Trust, London, United Kingdom
  5. 5 Health Data Research UK, London, United Kingdom
  6. 6 BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  7. 7 Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
  8. 8 University of Cambridge, Cambridge, Cambridgeshire, UK
  9. 9 Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
  10. 10 IQVIA Ltd, Reading, UK
  11. 11 Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  12. 12 Health Data Research UK Cambridge, Cambridge, UK
  13. 13 Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  14. 14 Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  15. 15 The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  16. 16 University of Dundee Health Informatics Centre, Dundee, UK
  17. 17 Population Health and Genomics, University of Dundee, Dundee, UK
  18. 18 Health Data Research UK Scotland, Edinburgh, United Kingdom
  19. 19 University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  20. 20 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  21. 21 Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
  22. 22 Health Data Research UK North, Sheffield, UK
  23. 23 School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
  24. 24 BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
  25. 25 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  26. 26 Cancer Research UK Edinburgh Centre, Institute of Genomic and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
  27. 27 BHF Data Science Centre, Health Data Research UK, London, UK
  28. 28 BHF/University Centre for Cardiovascular Science, Royal Infirmary of Edinburgh, Edinburgh, UK
  29. 29 Institute of Health Informatics, University College London, London, UK
  30. 30 Health Data Research UK South West, Population Health Sciences, University of Bristol, Bristol, UK
  31. 31 British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  32. 32 The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
  1. Correspondence to Dr Amitava Banerjee, Institute of Health Informatics, University College London. 222 Euston Road, London NW1 2DA, UK; ami.banerjee{at}ucl.ac.uk; Professor Cathie L M Sudlow; cathie.sudlow{at}hdruk.ac.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.

  • epidemiology
  • aortic and arterial disease
  • global health care delivery
  • health care delivery
  • heart disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2020-317870

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    Footnotes

    • Twitter @amibanerjee1, @wbradlow1, @MichaelPoon

    • Correction notice This article has been corrected since it was published Online First. The funding statement was updated to include 'Professor Suzanne Mason is funded by the National Institute for Health Research Yorkshire and Humber ARC. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.' Additionally, the middle initial R was added to Jonathan R Boyle.

    • Collaborators CVD-COVID-UK Consortium members are listed here: https://www.hdruk.ac.uk/wp-content/uploads/2020/07/CVD-COVID-UK-Consortium-Members-for-website-200722.pdf.

    • Contributors Study concept: AB, HH and CLMS. Study coordination: AB, RP and CLMS. Study design: AB, JB, BB, AS, RS, CLMS and WW. Data provision: SB, CB, JB, WB, AC, RC, JD, AD, FF, TJ, GK, KKL, PM, SM, NLM, EP, MP, JACS, FES, ZS and MW. Data analysis and online tool development: MTCP. Writing committee: AB, MTCP and CLMS (drafting); all other authors (subsequent revisions). Guarantors: AB and CLMS.

    • Funding CB is supported by the British Heart Foundation (RE/18/6134217). CS is supported by the British Heart Foundation and Health Data Research UK. RP is supported by the British Heart Foundation and Health Data Research UK. MP is supported by Health Data Research UK and the MRC Centre for Drug Safety Science. WW is supported by a Scottish Senior Fellowship from the Chief Scientist’s Office (CAF/17/01). JD holds a British Heart Foundation Personal Chair and is supported by grants from the British Heart Foundation, Health Data Research UK and the National Institute for Health Research. AC receives support from the Cambridge NIHR Biomedical Research Centre. MP is supported by Cancer Research UK Brain Tumour Centre of Excellence Aware (C157/A27589). Professor Suzanne Mason is funded by the National Institute for Health Research Yorkshire and Humber ARC. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Due to data governance from individual hospitals, we do not make data available. However, the data template and analysis approach are available on https://github.com/HDRUK/4C-Initiative.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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