Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries

F. Lucy Wright; Kate Cheema; Raph Goldacre; Nick Hall; Naomi Herz; Nazrul Islam; Zainab Karim; David Moreno-Martos; Daniel R. Morales; Daniel O'Connell; Enti Spata; Ashley Akbari; Mark Ashworth; Mark Barber; Norman Briffa; Dexter Canoy; Spiros Denaxas; Kamlesh Khunti; Amanj Kurdi; Mamas Mamas; Rouven Priedon; Cathie Sudlow; Eva J. A. Morris; Ben Lacey; Amitava Banerjee; CVD-COVID-UK Consortium

doi:10.1093/ehjqcco/qcac077

Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries

F. Lucy Wright
, Kate Cheema
, Raph Goldacre
, Nick Hall
, Naomi Herz
, Nazrul Islam
, Zainab Karim
, David Moreno-Martos
, Daniel R. Morales
, Daniel O'Connell
, Enti Spata
, Ashley Akbari
, Mark Ashworth
, Mark Barber
, Norman Briffa
, Dexter Canoy
, Spiros Denaxas
, Kamlesh Khunti
, Amanj Kurdi
, Mamas Mamas

Rouven Priedon, Cathie Sudlow, Eva J. A. Morris, Ben Lacey, Amitava Banerjee (Lead / Corresponding author), CVD-COVID-UK Consortium

Population Health and Genomics

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

153 Downloads (Pure)

Abstract

Background: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.

Methods: Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care.

Results: In 2020, there were 31 064 (-6%) fewer hospital admissions (14 506 [-4%] fewer emergencies, 16 560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions.

Conclusion: This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

Original language	English
Pages (from-to)	377–388
Number of pages	12
Journal	European Heart Journal - Quality of Care and Clinical Outcomes
Volume	9
Issue number	4
Early online date	16 Nov 2022
DOIs	https://doi.org/10.1093/ehjqcco/qcac077
Publication status	Published - Jun 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

General Medicine

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Cite this

Wright, F. L., Cheema, K., Goldacre, R., Hall, N., Herz, N., Islam, N., Karim, Z., Moreno-Martos, D., Morales, D. R., O'Connell, D., Spata, E., Akbari, A., Ashworth, M., Barber, M., Briffa, N., Canoy, D., Denaxas, S., Khunti, K., Kurdi, A., ... CVD-COVID-UK Consortium (2023). Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries. European Heart Journal - Quality of Care and Clinical Outcomes, 9(4), 377–388. https://doi.org/10.1093/ehjqcco/qcac077

@article{3c8073c9ac654f6498e28ec95f34ddc2,

title = "Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries",

abstract = "Background: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Methods: Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care.Results: In 2020, there were 31 064 (-6\%) fewer hospital admissions (14 506 [-4\%] fewer emergencies, 16 560 [-23\%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15\%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6\%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions.Conclusion: This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.",

author = "Wright, \{F. Lucy\} and Kate Cheema and Raph Goldacre and Nick Hall and Naomi Herz and Nazrul Islam and Zainab Karim and David Moreno-Martos and Morales, \{Daniel R.\} and Daniel O'Connell and Enti Spata and Ashley Akbari and Mark Ashworth and Mark Barber and Norman Briffa and Dexter Canoy and Spiros Denaxas and Kamlesh Khunti and Amanj Kurdi and Mamas Mamas and Rouven Priedon and Cathie Sudlow and Morris, \{Eva J. A.\} and Ben Lacey and Amitava Banerjee and \{CVD-COVID-UK Consortium\}",

note = "Funding Information: The British Heart Foundation Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS Digital) of the TRE, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser{\textquoteright}s National Core Studies programme to coordinate national covid-19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work, aligned to the priority themes as identified in the Welsh Government{\textquoteright}s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales Copyright: {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = jun,

doi = "10.1093/ehjqcco/qcac077",

language = "English",

volume = "9",

pages = "377–388",

journal = "European Heart Journal - Quality of Care and Clinical Outcomes",

issn = "2058-1742",

publisher = "Oxford University Press",

number = "4",

}

Wright, FL, Cheema, K, Goldacre, R, Hall, N, Herz, N, Islam, N, Karim, Z, Moreno-Martos, D, Morales, DR, O'Connell, D, Spata, E, Akbari, A, Ashworth, M, Barber, M, Briffa, N, Canoy, D, Denaxas, S, Khunti, K, Kurdi, A, Mamas, M, Priedon, R, Sudlow, C, Morris, EJA, Lacey, B, Banerjee, A & CVD-COVID-UK Consortium 2023, 'Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries', European Heart Journal - Quality of Care and Clinical Outcomes, vol. 9, no. 4, pp. 377–388. https://doi.org/10.1093/ehjqcco/qcac077

Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries. / Wright, F. Lucy; Cheema, Kate; Goldacre, Raph et al.
In: European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 9, No. 4, 06.2023, p. 377–388.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK

T2 - an electronic health record analysis across three countries

AU - Wright, F. Lucy

AU - Cheema, Kate

AU - Goldacre, Raph

AU - Hall, Nick

AU - Herz, Naomi

AU - Islam, Nazrul

AU - Karim, Zainab

AU - Moreno-Martos, David

AU - Morales, Daniel R.

AU - O'Connell, Daniel

AU - Spata, Enti

AU - Akbari, Ashley

AU - Ashworth, Mark

AU - Barber, Mark

AU - Briffa, Norman

AU - Canoy, Dexter

AU - Denaxas, Spiros

AU - Khunti, Kamlesh

AU - Kurdi, Amanj

AU - Mamas, Mamas

AU - Priedon, Rouven

AU - Sudlow, Cathie

AU - Morris, Eva J. A.

AU - Lacey, Ben

AU - Banerjee, Amitava

AU - CVD-COVID-UK Consortium

N1 - Funding Information: The British Heart Foundation Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS Digital) of the TRE, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national covid-19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work, aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/6

Y1 - 2023/6

N2 - Background: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Methods: Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care.Results: In 2020, there were 31 064 (-6%) fewer hospital admissions (14 506 [-4%] fewer emergencies, 16 560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions.Conclusion: This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

AB - Background: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Methods: Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care.Results: In 2020, there were 31 064 (-6%) fewer hospital admissions (14 506 [-4%] fewer emergencies, 16 560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions.Conclusion: This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

UR - https://www.scopus.com/pages/publications/85163820433

U2 - 10.1093/ehjqcco/qcac077

DO - 10.1093/ehjqcco/qcac077

M3 - Article

C2 - 36385522

SN - 2058-1742

VL - 9

SP - 377

EP - 388

JO - European Heart Journal - Quality of Care and Clinical Outcomes

JF - European Heart Journal - Quality of Care and Clinical Outcomes

IS - 4

ER -

Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries

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