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Original research
Place and causes of acute cardiovascular mortality during the COVID-19 pandemic
  1. Jianhua Wu1,2,
  2. Mamas A Mamas3,
  3. Mohamed O Mohamed4,
  4. Chun Shing Kwok5,
  5. Chris Roebuck6,
  6. Ben Humberstone7,
  7. Tom Denwood6,
  8. Thomas Luescher8,
  9. Mark A de Belder9,
  10. John E Deanfield10,
  11. Chris P Gale1,11,12
  1. 1 Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
  2. 2 Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK
  3. 3 Keele Cardiovascular Reserach Group, Keele University, Keele, Staffordshire, UK
  4. 4 Keele Cardiovascular Research Group, Research Institute for Primary Care and Health Sciences, Keele, UK
  5. 5 Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
  6. 6 NHS Digital, Leeds, UK
  7. 7 Office for National Statistics, New Port, UAE
  8. 8 Imperial College, London, UK
  9. 9 Barts NHS Trust, London, UK
  10. 10 UCL, London, UK
  11. 11 Leeds Insitutue of Cardiovascualr and Metabolic Medicine, University of Leeds, UK
  12. 12 Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Prof Chris P Gale, Leeds Insitutue of Cardiovascualr and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK; c.p.gale{at}


Objective To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.

Methods Retrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death.

Results After 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.

Conclusions and relevance The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.

  • acute coronary syndromes
  • stroke

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Twitter @MMamas1973, @DrShingKwok, @cpgale3

  • Contributors CPG and JW was responsible for the study design and concept. JW performed the data cleaning and analysis. JW and CPG wrote the first draft of the manuscript, and all authors contributed to the writing of the paper.

  • Funding JW and CPG are funded by the University of Leeds. MAM is funded by the University of Keele.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was not required as this study used fully anonymised routinely collected civil registration deaths data. The data analysis was conducted through remote access to NHS Digital Data Science Server.

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

  • Data availability statement Data may be obtained from a third party upon ethical approval and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The Secretary of State for Health and Social Care has issued a time limited Notice under Regulation 3(4) of the NHS (Control of Patient Information Regulations) 2002 to share confidential patient information.

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