Excess Deaths: Study Shows 2085 Excess Deaths In England And Wales Due To Cardiovascular Issues During COVID-19 Pandemic
: A University of Leeds led study has shown that there were more than 2085 excess deaths in England and Wales due to heart disease and stroke during the peak of the COVID-19 pandemic stretching over 4 months (2nd
March to 30th
June 2020) with an average of 17 deaths per day. The researchers say that most of these deaths could have been prevented. (Excess deaths are the number of deaths above what is normally expected)
The study findings were published in the British Medical Journal: Heart https://heart.bmj.com/content/early/2020/09/28/heartjnl-2020-317912
The study team believes the excess deaths were caused by individuals not seeking emergency hospital treatment for a heart attack or other acute cardiovascular illness requiring urgent medical attention, either because they were afraid of contracting COVID-19 or were not referred for treatment.
Over some speculate that the SARS-Cov-2 could also be a another major contributing factor as the COVID-19 disease is known to cause clotting issues, strokes and myocarditis which can result in heart failures in both symptomatic and asymptomatic infected individuals.
It was also reported that over the same period, there was a sharp rise in the proportion of individuals who died at home or in a care home from acute cardiovascular diseases.
Dr Chris Gale, Professor Cardiovascular Medicine at the University of Leeds told Thailand Medical News, "It is entirely plausible that a number of deaths could have been prevented if individuals had attended hospital quickly when they began to experience their heart attack or stroke. The sad irony is that previous research we have undertaken showed that nationwide heart attack services remained fully operational and continued to deliver high quality care during the peak of the pandemic."
The research was carried out by a team of data scientists and clinicians, led by academics at the University of Leeds. The other collaborators were from Keele University, NHS Digital, the Office for National Statistics, Barts Health NHS Trust, and University College London.
This would be the third major study from academics investigating how the peak of the COVID-19 pandemic affected emergency cardiovascular services.
Associate Professor in the School of Medicine at Leeds, Dr Jianhua Wu, led the latest study.
Dr Wu commented, "This study is the first to give a detailed and comprehensive picture of what was happening to individuals who were acutely ill with cardiovascular disease cross England and Wales. It reveals a large number of excess deaths. The findings will help Government and the NHS to develop messages that ensure people who are very ill do seek help."
The detailed analysis looked at the information that is collected when a death certificate is issued. It details the cause of death and where the person died. To provide baseline data, the study looked at cardiovascular deaths from the 1 January 2014 through to 30 June 2020.
It was found that in the four months starting
from 2 March, 2020, when the first COVID-19 death was registered in the UK to 30 June, there were 28,969 cardiovascular deaths.
This was compared to the average number of deaths seen for the same period over each of the previous six years. It was eight percent higher, revealing 2085 excess deaths. The excess cardiovascular deaths began to emerge in late March 2020 and peaked in early April, this was at the time the Government was promoting its 'Stay at home, Protect the NHS, Save lives' messages. That may have resulted in fewer individuals being prepared to go to hospital when they were becoming ill, either because they were worried about becoming infected by COVID-19 or were worried about overwhelming the NHS.
Past research by the study team, published in The Lancet and European Heart Journal: “Quality of Care and Clinical Outcomes”, have revealed that the number of individuals arriving at hospital with a heart attack fell sharply, with some units seeing just over half the expected number of cases.
The study findings also revealed a shift in where individuals were dying. There were proportionately fewer deaths in hospital compared to the baseline data: 53.4 percent versus 63 percent. Proportionately more deaths were happening at home: 30.9 percent v 23.5 percent and in care homes: 15.7 percent v 13.5 percent. Excess deaths were disproportionately happening at home; up by 35 percent when compared with what would be expected, and in care homes, up by 32 percent increase.
In the research, the study team noted, "This 'displacement of death', most likely, signifies that the public either did not seek help or were not referred to hospital during the pandemic."
It was found that for individuals in care homes and hospices, the most prevalent cause of death was stroke and heart failure. For those who died at home, it was heart attack or heart failure. Pulmonary embolism and cardiogenic shock, where the heart can't supply enough blood to the body, were the most frequent causes of death for those who died in hospital.
Dr Gale added, "Our research has revealed that individuals who died at home were most likely to have had a heart attack. This is further support for the speculation that many individuals were staying away from hospital even though they were very ill with an acute cardiovascular illness. The reality of an untreated heart attack is that it will cause complications and that will either lead to death, heart failure or life-threatening heart rhythms. The messages that went out at the time of lockdown were important. “
He further added, ”The UK NHS did need protecting from a potential surge of COVID-19 cases. But some people may have taken the messaging to mean that the NHS was not able to cope if they had a medical emergency, or that hospitals were a place where they would catch the contagion. As the NHS prepares for any future wave of COVID-19, it needs to ensure individuals clearly understand that hospitals are open and have processes in place to minimize the risks of patients becoming infected with COVID-19."
The researchers admitted that their study had limitations. “During the COVID-19 pandemic, emergency guidance enabled any doctor in the UK (not just the attending) to complete the MCCD, the duration of time over which the deceased was not seen before referral to the coroner was extended from 14 to 28 days, and causes of death could be ‘to the best of their knowledge and belief’ without diagnostic proof, if appropriate and to avoid delay.23
This may have resulted in misclassification bias, with under-reporting of the deaths directly due to CV disease in preference to COVID-19 infection (which is a notifiable disease under the Health Protection (Notification) Regulations 2010) or respiratory disease. In fact, we found that MCCDs with COVID-19 certification less frequently contained details of acute CV events directly leading to death. Although the MCCD allows the detailing of the sequence of events directly leading to death, we found that after 2 March 2020 few (5.7%) had multiple acute CV events recorded, and therefore the categorization of the acute CV events effectively represents per-patient events. “
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