Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK

CVD-COVID-UK Consortium, Simon Ball, Amitava Banerjee (Lead / Corresponding author), Colin Berry, Jonathan Boyle, Benjamin Bray, William Bradlow, Afzal Chaudhry, Rikki Crawley, John Danesh, Alastair Denniston, Florian Falter, Jonine D. Figueroa, Christopher Hall, Harry Hemingway, Emily Jefferson, Tom Johnson, Graham King, Kuan Ken Lee, Paul McKeanSuzanne Mason, Nicholas L. Mills, Ewen Pearson, Munir Pirmohamed, Michael T. C. Poon, Rouven Priedon, Anoop Shah, Reecha Sofat, Jonathan A. C. Sterne, Fiona E. Strachan, Cathie L. M. Sudlow (Lead / Corresponding author), Zsolt Szarka, William Whiteley, Michael Wyatt

Research output: Contribution to journalArticlepeer-review

72 Citations (Scopus)
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Objective: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects.

Methods: Retrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018-2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends.

Results: Across nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%-58.6%) and 52.9% (52.2%-53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown and fell by 31%-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020.

Conclusions: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

Original languageEnglish
Pages (from-to)1890-1897
Number of pages8
JournalHeart (British Cardiac Society)
Issue number24
Early online date5 Oct 2020
Publication statusPublished - 1 Dec 2020


  • aortic and arterial disease
  • epidemiology
  • global health care delivery
  • health care delivery
  • heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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