The COVID-19 pandemic posed major challenges for healthcare services in the UK. The NHS reorganised itself to focus primarily on the expected influx of people who had become severely ill with the coronavirus. The Government heavily promoted its ‘Stay at Home’, ‘Protect the NHS’ and ‘Save Lives’ messaging. What impact did this have on people who became ill with other medical emergencies?
A unique collaboration between academic researchers, the NHS, specialist disease registries and NHS Digital is enabling the rapid evaluation of the impact of the pandemic on the wider healthcare system. The intelligence that comes from this data analysis is helping the Government and the NHS to better plan for a second wave of COVID-19, should it emerge.
Researchers at the Leeds Institute for Data Analytics have been at the forefront of an academic collaboration to monitor the impact of COVID-19 on emergency cardiac services, morbidity and mortality rates. The first paper used Hospital Episodes Statistics, data kept on every hospital admission and A+E attendance, to report the decline in people arriving at hospital having a heart attack. It was published in The Lancet in July 2020.
The research consortium also analysed whether sex difference and underlying health conditions were linked to an increased risk of death from COVID-19. That study is published in the Mayo Clinic Proceedings.
The research consortium has utilised the livefeed datasets provided by the National Institute for Cardiovacular Outcomes Resarch (NICOR) during the pandemic. NICOR has published a report to summarise the impact of the COVID-19 pandemic on the care of people with cardiovascular disease.
In addition, researchers have been using data collected as part of MINAP, the Myocardial Ischaemia National Audit Project. Information held with MINAP gives details of the ‘patient journey’ – such as, the time it takes for people who have had a heart attack to seek help and the treatment they receive at hospital along with details of their other illnesses and conditions. The audit also captures mortality data.
During the pandemic, data from MINAP were sent to NHS Digital before being released, iteratively, into a secure environment to the researchers.
A paper, published in the European Heart Journal – Quality of Care and Clinical Outcomes, details the findings of the MINAP analysis during the early phase of the lockdown. It confirms the substantial decline in patients attending hospital with a heart attack over the weeks leading up to 23 March, the day that lockdown started – and the subsequent two months.
In the first month of lockdown, hospitals in England saw just over half the number of heart attack cases they would expect to see. The numbers did rebound to some extent but by 30 September, when the first phase of the study ended, they were not back to the levels seen pre COVID-19.
Inevitably, the consequence of people not seeking medical help for a heart attack is that they will either die – or will develop heart failure, requiring early treatment and long-term support from the NHS.
You can read more about this study on the hospitalisation of AMI during COVID-19 pandemic page.
We and others have shown a substantial reduction in presentations to hospitals with acute cardiovascular (CV) conditions including acute coronary syndrome, heart failure, cardiac arrhythmia and stroke during the pandemic. This would be expected to result in a much higher number of deaths, unless there has been an actual decrease in the incidence of these acute conditions.
A paper, published in the Heart medical journal, details the findings of excess acute cardiovascular deaths during COVID-19 pandemic. Using livefeed Civil Registration Deaths Data of the Office for National Statistics (ONS) of England and Wales, w reported, with high temporal resolution, CV specific mortality during COVID-19. In particular, we have evaluated the location of CV deaths (e.g. hospitals, home or care homes), their relation to COVID-19 infection and the specific CV fatal events that contributed directly to death.
We found that during the pandemic there has been an inflation in acute CV deaths above that expected for the time of year. Care homes had the greatest increase in excess acute CV death, and the most frequent cause of acute CV death during this period was stroke, followed by acute coronary syndrome.
These contemporary nationwide cause and place of mortality data provide key information to optimise messaging to the public, as well as for allocation of health resources and planning.
You can read more about this study on the excess acute cardiovascular deaths during COVID-19 pandemic page.
As the UK responds to a second wave of COVID-19 infections, Chris Gale – Professor of Cardiovascular Medicine at Leeds – urges people who might be experiencing a heart attack to seek immediate medical help. Research has shown thousands of excess deaths from cardiovascular disease during the first wave of the pandemic, probably because patients were afraid of going to hospital and catching COVID-19. But studies have shown emergency heart attack services operated safely and to a high clinical standard. Watch Professor Gale’s message:
As more data become available, researchers at Leeds will update the information on this website (last updated on 27th Nov 2020).