Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK
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Abstract
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.
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SciScore for 10.1101/2020.07.10.20151118: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: The simple, aggregate nature of our data request enabled a large proportion of the hospitals contacted to provide data in a short timeframe. This has made possible the notion of a regularly updated online tool that can incorporate and display near real-time data from an increasing number of hospitals across the UK. However, the aggregate nature of the data means that the influence of individual level factors such as …
SciScore for 10.1101/2020.07.10.20151118: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: The simple, aggregate nature of our data request enabled a large proportion of the hospitals contacted to provide data in a short timeframe. This has made possible the notion of a regularly updated online tool that can incorporate and display near real-time data from an increasing number of hospitals across the UK. However, the aggregate nature of the data means that the influence of individual level factors such as age, socioeconomic status, ethnicity and comorbidities cannot be explored. Further, our current data request combines data on the primary and other (secondary) reasons for hospital admission, and does not subdivide admissions or procedures according to elective (planned) and emergency (unplanned) activity. Future modifications of our data collection procedures could enable separate analysis of elective and emergency procedures. Finally, we used data from the previous calendar year as a comparator to calculate percentage change in activity. While data averaged across the previous five years may provide a more stable comparator and has been used to assess excess mortality from national mortality data, such data would mask longer term trends in some activities (e.g. reductions in carotid endarterectomies and aortic aneurysm repairs and increasing numbers of procedures for peripheral arterial disease30), hospitals may have found it more challenging to provide these data, and changes in hospital catchment areas and service arrangements would ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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