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

Heart. 2021 Jan;107(2):113-119. doi: 10.1136/heartjnl-2020-317912. Epub 2020 Sep 28.

Abstract

Objective: 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.

Keywords: acute coronary syndromes; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome* / etiology
  • Acute Coronary Syndrome* / mortality
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • Causality
  • Cause of Death*
  • England / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends*
  • Outcome and Process Assessment, Health Care
  • Residence Characteristics / statistics & numerical data
  • Retrospective Studies
  • SARS-CoV-2 / isolation & purification
  • Stroke* / etiology
  • Stroke* / mortality