Prof Chris P Gale Profile picture
Jul 16, 2020 8 tweets 6 min read Read on X
In reply @VijayKunadian : 1) we know there is an excess of deaths (when all-causes as a single group are studied) (@d_spiegel);
2) there will also be an excess of #cardiovascular deaths (we will release a pre-print shortly for external review @mmamas1973). I think it is very likely people did not come to #hospital - we know that failure to treat MI results in premature death.
(However, limitations in arbitration of cause, ‘default’ to #COVID19 as a cause, & latent effects of missed #heartattack will produce mis-classification bias & an underestimation of the extent of the deaths from not seeking help)
3) there is no carcinogenic shock registry & if there were it would be hospital based (& not cover the full populace by place of incident event - ie it would underestimate) @agershlick
4) many ‘surviving’ #cardiovasvular events will have been spatially displaced (ie stayed at home or care home with #heartattack, @mancunianmedic) & some of these will not have been recorded (or cause stated) as #heartattack or the complications of.
5) there is no full populace #heartfailure registry - even if we link hospital (HES) data with primary care data there could be mis-classification of incidence given that #HF may be stated but not the cause of it. @BSHeartFailure
6) ultimately, tracking the life (health) course of the full populace across all places would provide answers, but until that day we are left with inferences from excellent #datasets that concentrate on specific diseases or specific places of care.
7) finally, live feeds of high quality populace #data are essential if we wish to monitor & therefore improve the health of the nation (our @lancet publication was rapid, yet remains retrospective, & reactive) @MattHancock

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More from @cpgale3

Sep 28, 2020
This nationwide complete analysis of all adult deaths in #England & #Wales has found that the #COVID pandemic has resulted in an abrupt inflation in acute #cardiovascular deaths above that expected for the time of year. heart.bmj.com/content/early/…
That is, about 2000 additional deaths over a 4 month period.
Nearly half of the deaths occurred outside of the #hospital setting, either at #home or in #carehomes.
Read 23 tweets
Sep 23, 2020
Emerging data from @PHE_uk suggests a synergistic detrimental effect of co-infection with #SARS_CoV_2 & #flu viruses. The preprint (not peer reviewed) article is available here medrxiv.org/content/10.110…
‘The risk of testing positive for #SARS_CoV_2 was 68% lower among #influenza positive cases, suggesting possible pathogenic competition between the two viruses.’
However, ‘Patients with a coinfection had a risk of death of 5.92 (95% CI, 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2 suggesting possible synergistic effects in coinfected individuals.’
Read 7 tweets
Sep 20, 2020
Advances in #cancer treatment have improved clinical outcomes, leading to an increasing population of cancer survivors. Yet, this success is associated with high rates of short‐ & long‐term #cardiovascular toxicities. The Cancer Patient and Cardiology onlinelibrary.wiley.com/doi/abs/10.100…
The number & variety of #cancer drugs & #cardiovascular toxicity types make long‐term care a complex undertaking.
This requires a multidisciplinary approach including expertise from #oncology, #cardiology, & other related specialties, & has led to the development of the cardio‐oncology subspecialty.
Read 10 tweets
Sep 20, 2020
The rise in admissions with #COVID19 does not mean that you shouldn’t attend hospital if you have a medical emergency #heartattack Image
During the first peak, admissions with #heartatrack declined & was of grave concern : COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England @TheLancet thelancet.com/journals/lance…
Yet, hospitals provided high quality care for those who did attend: Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic @ESC_Journals #EHJQCCO academic.oup.com/ehjqcco/advanc…
Read 6 tweets
Sep 19, 2020
Subsequent to #Surgisphere, all @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world #datasets. thelancet.com/journals/lance…
@TheLancet journals now require all #research papers, irrespective of method, to include a data-sharing statement that details what #data will be shared, whether additional documents will be shared, when data will become available & by what access criteria data will be shared.
All @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world datasets.
Read 10 tweets
Sep 19, 2020
Patients with mitral annular disjunction present with frequent premature ventricular contractions; in this study, one-third had ventricular arrhythmias & one-tenth had severe arrhythmic events. @JACCJournals onlinejacc.org/content/72/14/…
A total of 82 (71%) patients reported #palpitations, 47 (41%) patients reported previous pre-syncope, 40 (34%) had ventricular arrhythmia, 15 (13%) had experienced #syncope, & 14 (12%) patients had experienced a severe arrhythmic event prior to inclusion
Mitral valve prolapse was present in 90 (78%) patients
Read 10 tweets

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