Lower hospitalization rates for urgent heart problems in the early stages of the COVID-19 pandemic may have contributed to preventable deaths in England, according to a new study by UCL researchers.
In the wake of the coronavirus pandemic, a significant decrease in patient visits to emergency rooms (EDs) has been seen in England and the US, including those with heart problems.
In this study published online in the journal Circulatory Cardiovascular Quality and ResultsResearchers at the UCL Institute of Health Informatics estimated the impact of reduced ED visits for suspected heart disease on non-COVID-19 heart mortality in England.
To quantify the number of excessive deaths from heart disease, the team used the Office of National Statistics (ONS) mortality figures for England. To quantify the change in daily ED visits, researchers used data from the Public Health England Emergency Department’s Syndrome Monitoring System (EDSSS) (PHE): a network of Sentinel EDs across England. To find out how reducing ED visits might have impacted heart mortality, the researchers implemented a causal inference method.
The lead author Dr. Mikhail Katsoulis (UCL Health Informatics Institute) said: “In the initial stages of the pandemic between March 12 and April 15, 2020, there were an estimated fewer ED visits of 2,750 per week for suspected heart disease, a decrease of around 35 % compared to the pre-pandemic this year.
“Our analysis found that an additional 12 ED visits may have prevented or delayed cardiac death if heart disease was suspected. We estimated that excessive cardiac mortality from failure to participate in EDs during the early stages of the pandemic was as high as 232 deaths per week. “
While the decline in the number of patients having access to hospital care during the pandemic is well documented, here we provide an estimate of the health impact of this change in health care use. “
Lead author Dr. Tom Lumbers, lead study author, University College London Institute of Health Informatics
“Public health reporting to protect the NHS may have resulted in patients not participating in ED out of fear or public concerns or difficulties in accessing services due to the pandemic.
“Our results suggest that the pandemic response may have resulted in the under-treatment of non-COVID-19 diseases, including heart disease, with important implications for the excess mortality observed during this period.”
Dr. Lumbers added, “These results provide evidence of the strong indirect effects of the COVID-19 pandemic on mortality in England. There is a need to better understand how the pandemic response led to a decrease in participation in EDs with suspected heart disease and others Illnesses led serious illnesses to inform future strategies to mitigate the direct and indirect effects of the pandemic. “
The research team’s estimates are based on the assumption that the COVID-19 pandemic will only affect excessive deaths from heart disease by reducing ED intake, and not due to other factors such as increased stress and anxiety.
Another possible limitation of this study is the possible misclassification of cardiac death as unrelated to COVID-19, as SARS-CoV-2 virus infection was excluded for clinical reasons and not through systematic viral ribonucleic acid tests.
University College London
Katsoulis, M., et al. (2020) Estimation of the impact of reduced attendance in emergency rooms for suspected heart disease on cardiac mortality during the COVID-19 pandemic. Circulation: Cardiovascular Quality and Results. doi.org/10.1161/CIRCOUTCOMES.120.007085.