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.
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Ball, S., Banerjee, A., Berry, C., Boyle, J., Bray, B., Bradlow, W., Chaudhry, A., Crawley, R., Danesh, J., Denniston, A., Falter, F., Figueroa, J., Hall, C., Hemingway, H., Jefferson, E., Johnson, T., King, G., Lee, K., McKean, P., Mason, S., Mills, N., Pearson, E., Pirmohamed, M., Poon, M., Priedon, R., Shah, A., Sofat, R., Sterne, J., Strachan, F., Sudlow, C., Szarka, Z., Whiteley, W. & Wyatt, M. 2020, 'Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK', Heart, 106(24), pp. 1890-1897. https://doi.org/10.1136/heartjnl-2020-317870