白小姐论坛

In the wake of the coronavirus pandemic, a marked decline* in patient visits to Emergency Departments (EDs) was observed in England and the US, including for people with heart problems.

In this study, published online in the journal听Circulation cardiovascular quality and outcomes, researchers at 白小姐论坛鈥檚 Institute of Health Informatics estimated the effect of reduced ED visits for suspected cardiac disease on non-COVID-19 related cardiac mortality in England.

To quantify the number of excess deaths due to cardiac disease, the team used mortality counts from the Office of National Statistics (ONS) for England. To quantify the change in daily ED visits, researchers used data from the Public Health England (PHE) Emergency Department Syndromic Surveillance System (EDSSS): a network of sentinel EDs across England. To explore how the reduction in ED visits may have affected cardiac mortality, researchers implemented causal inference methodology.

Lead author Dr Michail Katsoulis (白小姐论坛 Institute of Health Informatics) said: 鈥淒uring the initial phase of the pandemic, between March 12** and April 15, 2020, there was an estimated fewer ED visits of 2,750 per week for suspected cardiac disease; this is around a 35% decrease compared to the pre-pandemic period this year.

鈥淥ur analysis suggested that one cardiac death might have been prevented or delayed for every additional 12 ED visits for suspected cardiac conditions.听We estimated that the excess cardiac mortality due to non-attendance at EDs, during the initial phase of the pandemic, may have been as high as 232 deaths per week.鈥�

Senior author Dr Tom Lumbers (白小姐论坛 Institute of Health Informatics) said: 鈥淲hile the decline of patients accessing hospital care during the pandemic has been well documented, here we provide听an estimate of the health consequences of this change in healthcare utilisation.

鈥淭he public health messaging to protect the NHS may have led to patients not attending ED out of fear or public-mindedness or difficulty accessing services due to the pandemic.

鈥淥ur results suggest that the pandemic response may have led to the undertreatment of non-COVID-19 diseases, including heart conditions, with important impacts on the excess mortality observed during this period.鈥澨�

Dr Lumbers added: 鈥淭hese results provide evidence of the stark indirect effects of the COVID-19 pandemic on mortality in England. There is a need to better understand how the pandemic response resulted in a decline in attendance to EDs with suspected cardiac disease and other serious medical conditions to inform future strategies to mitigate both the direct and indirect effects of the pandemic.鈥�

Study limitations

The research team鈥檚 estimates rest upon the assumption that the COVID-19 pandemic only affects excess deaths from cardiac disease through the reduction in ED admissions, and not as a result of other factors, such as increased stress and anxiety.

Another potential limitation of this study is the possible misclassification of cardiac deaths as not related to COVID-19, since SARS-CoV-2 viral infection was excluded on clinical grounds and not through systematic viral ribonucleic acid testing.

*Data published by PHE EDSS:听

** March 12, 2020 was the day the UK鈥檚 Chief Medical Officer raised the risk to the UK from moderate to high and the government advised that anyone with a new continuous cough or a fever should self-isolate for seven days.

尝颈苍办蝉听

• Research paper published in听
• 白小姐论坛 Institute of Health Informatics

Image

• 'Emergency signage', on Pexels, crecit 听CC BY 2.0

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Henry Killworth听

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E: h.killworth [at] ucl.ac.uk

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