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Patients with cardiovascular disease (CVD) have an increased mortality risk with COVID-19 infection yet several studies have shown fewer hospital-based CVD diagnoses and procedures during the COVID-19 pandemic. In this issue of Heart, Wu and colleagues1 show that despite a decrease in the number of patients presenting with an acute CVD event there was an 8% excess of CVD deaths in England between March and June 2020 (during the COVID-19 pandemic), compared with the previous 6 years (figure 1). About ½ of these deaths occurred outside the hospital with the most frequent causes of CVD death being stroke (35.6%), acute coronary syndrome (24.5%), heart failure (23.4%) pulmonary embolism (9.3%) and cardiac arrest (4.6%). Most of these deaths were not related to a known COVID-19 infection, suggesting they were most likely due to delays in seeking medical care or undiagnosed COVID-19 infection.
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