Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

Amitava Banerjee; Suliang Chen; Laura Pasea; Alvina G Lai; Michail Katsoulis; Spiros Denaxas; Vahe Nafilyan; Bryan Williams; Wai Keong Wong; Ameet Bakhai; Kamlesh Khunti; Deenan Pillay; Mahdad Noursadeghi; Honghan Wu; Nilesh Pareek; Daniel Bromage; Theresa A McDonagh; Jonathan Byrne; James T H Teo; Ajay M Shah; Ben Humberstone; Liang V Tang; Anoop S V Shah; Andrea Rubboli; Yutao Guo; Yu Hu; Cathie L M Sudlow; Gregory Y H Lip; Harry Hemingway

doi:10.1093/eurjpc/zwaa155

Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

Amitava Banerjee^*, Suliang Chen, Laura Pasea, Alvina G Lai, Michail Katsoulis, Spiros Denaxas, Vahe Nafilyan, Bryan Williams, Wai Keong Wong, Ameet Bakhai, Kamlesh Khunti, Deenan Pillay, Mahdad Noursadeghi, Honghan Wu, Nilesh Pareek, Daniel Bromage, Theresa A McDonagh, Jonathan Byrne, James T H Teo, Ajay M ShahBen Humberstone, Liang V Tang, Anoop S V Shah, Andrea Rubboli, Yutao Guo, Yu Hu, Cathie L M Sudlow, Gregory Y H Lip, Harry Hemingway

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

85 Citations (Scopus)

37 Downloads (Pure)

Abstract

AIMS: Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare.

METHODS AND RESULTS: We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths.

CONCLUSION: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.

Original language	English
Article number	zwaa155
Journal	European Journal of Preventive Cardiology
Volume	28
Issue number	14
Pages (from-to)	1599-1609
Number of pages	11
ISSN	2047-4873
DOIs	https://doi.org/10.1093/eurjpc/zwaa155
Publication status	Published - 20 Dec 2021

Keywords

COVID-19
Cardiovascular Diseases/diagnosis
Communicable Disease Control
Humans
Pandemics
SARS-CoV-2

Access to Document

10.1093/eurjpc/zwaa155Licence: CC BY-NC 4.0

Banerjee et al. (2021) Excess deaths in people with cardiovascular diseases during the COVID-19 pandemicFinal published version, 2.48 MBLicence: CC BY-NC 4.0

AUB Link

Search for the material in Aalborg University Library's search engine

Cite this

Banerjee, A., Chen, S., Pasea, L., Lai, A. G., Katsoulis, M., Denaxas, S., Nafilyan, V., Williams, B., Wong, W. K., Bakhai, A., Khunti, K., Pillay, D., Noursadeghi, M., Wu, H., Pareek, N., Bromage, D., McDonagh, T. A., Byrne, J., Teo, J. T. H., ... Hemingway, H. (2021). Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic. European Journal of Preventive Cardiology, 28(14), 1599-1609. Article zwaa155. Advance online publication. https://doi.org/10.1093/eurjpc/zwaa155

@article{2fe5476d4c004620a8e5c0fc0cb69107,

title = "Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic",

abstract = "AIMS: Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare.METHODS AND RESULTS: We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths.CONCLUSION: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.",

keywords = "COVID-19, Cardiovascular Diseases/diagnosis, Communicable Disease Control, Humans, Pandemics, SARS-CoV-2",

author = "Amitava Banerjee and Suliang Chen and Laura Pasea and Lai, {Alvina G} and Michail Katsoulis and Spiros Denaxas and Vahe Nafilyan and Bryan Williams and Wong, {Wai Keong} and Ameet Bakhai and Kamlesh Khunti and Deenan Pillay and Mahdad Noursadeghi and Honghan Wu and Nilesh Pareek and Daniel Bromage and McDonagh, {Theresa A} and Jonathan Byrne and Teo, {James T H} and Shah, {Ajay M} and Ben Humberstone and Tang, {Liang V} and Shah, {Anoop S V} and Andrea Rubboli and Yutao Guo and Yu Hu and Sudlow, {Cathie L M} and Lip, {Gregory Y H} and Harry Hemingway",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2021",

month = dec,

day = "20",

doi = "10.1093/eurjpc/zwaa155",

language = "English",

volume = "28",

pages = "1599--1609",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

number = "14",

}

Banerjee, A, Chen, S, Pasea, L, Lai, AG, Katsoulis, M, Denaxas, S, Nafilyan, V, Williams, B, Wong, WK, Bakhai, A, Khunti, K, Pillay, D, Noursadeghi, M, Wu, H, Pareek, N, Bromage, D, McDonagh, TA, Byrne, J, Teo, JTH, Shah, AM, Humberstone, B, Tang, LV, Shah, ASV, Rubboli, A, Guo, Y, Hu, Y, Sudlow, CLM, Lip, GYH & Hemingway, H 2021, 'Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic', European Journal of Preventive Cardiology, vol. 28, no. 14, zwaa155, pp. 1599-1609. https://doi.org/10.1093/eurjpc/zwaa155

TY - JOUR

T1 - Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

AU - Banerjee, Amitava

AU - Chen, Suliang

AU - Pasea, Laura

AU - Lai, Alvina G

AU - Katsoulis, Michail

AU - Denaxas, Spiros

AU - Nafilyan, Vahe

AU - Williams, Bryan

AU - Wong, Wai Keong

AU - Bakhai, Ameet

AU - Khunti, Kamlesh

AU - Pillay, Deenan

AU - Noursadeghi, Mahdad

AU - Wu, Honghan

AU - Pareek, Nilesh

AU - Bromage, Daniel

AU - McDonagh, Theresa A

AU - Byrne, Jonathan

AU - Teo, James T H

AU - Shah, Ajay M

AU - Humberstone, Ben

AU - Tang, Liang V

AU - Shah, Anoop S V

AU - Rubboli, Andrea

AU - Guo, Yutao

AU - Hu, Yu

AU - Sudlow, Cathie L M

AU - Lip, Gregory Y H

AU - Hemingway, Harry

PY - 2021/12/20

Y1 - 2021/12/20

N2 - AIMS: Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare.METHODS AND RESULTS: We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths.CONCLUSION: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.

AB - AIMS: Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare.METHODS AND RESULTS: We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths.CONCLUSION: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.

KW - COVID-19

KW - Cardiovascular Diseases/diagnosis

KW - Communicable Disease Control

KW - Humans

KW - Pandemics

KW - SARS-CoV-2

U2 - 10.1093/eurjpc/zwaa155

DO - 10.1093/eurjpc/zwaa155

M3 - Journal article

C2 - 33611594

SN - 2047-4873

VL - 28

SP - 1599

EP - 1609

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 14

M1 - zwaa155

ER -

Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

Abstract

Keywords

Access to Document

AUB Link

Fingerprint

Cite this