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.
- aortic and arterial disease
- global health care delivery
- health care delivery
- heart disease
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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.
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