Place and causes of acute cardiovascular mortality during the COVID-19 pandemic

  1. Jianhua Wu
  2. Mamas A Mamas
  3. Mohamed O Mohamed
  4. Chun Shing Kwok
  5. Chris Roebuck
  6. Ben Humberstone
  7. Tom Denwood
  8. Thomas Luescher
  9. Mark A de Belder
  10. John E Deanfield
  11. Chris P Gale

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

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.

Article activity feed

  1. Version published to 10.1136/heartjnl-2020-317912
  2. ScreenIT

    SciScore for 10.1101/2020.07.14.20153734: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Nonetheless, our study has limitations. During the COVID19 pandemic, emergency guidance enabled any doctor in the UK (not just the attending) to complete the MCCD, the duration of time over which the deceased was not seen before referral to the coroner was extended from 14 to 28 days, and causes of death could be “to the best of their knowledge and belief” without diagnostic proof, if appropriate and to avoid delay.23 This may have resulted in misclassification bias, with underreporting of the deaths directly due to CV disease in preference to COVID19 infection (which is a notifiable disease under the Health Protection (Notification) Regulations 2010) or respiratory disease. In fact, we found that MCCDs with COVID-19 certification less frequently contained details of acute CV events directly leading to death. Although the MCCD allows the detailing of the sequence of events directly leading to death, we found that after 2nd March 2020 few (5.7%) had multiple acute CV events recorded, and therefore the categorisation of the acute CV events effectively represents per patient events. The lower proportion of deaths with COVID-19 at home and in care homes may represent the lack of access to community-based COVID19 testing. Equally, because there was no systematic testing of the UK populace for the presence the COVID-19, deaths associated with the infection may have been under estimated.24 This analysis will have excluded a small proportion of deaths under review by the Coroner, tho...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.07.14.20153734v1 on medRxiv