Prof Chris P Gale Profile picture
Sep 28, 2020 23 tweets 18 min read Read on X
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.
The greatest proportional increase in excess acute #cardiovascular deaths occurred in people’s homes.
The most frequent cause of acute #cardiovascular death during the #COVID19 pandemic in #England & #Wales was #stroke followed by #heartattack & #heartfailure.
We studied all adult acute #cardiovascular deaths (n=587,225) in England & Wales, between 1st January 2014 & 30th June 2020.
After 2nd March 2020, there were 28,969 acute #cardiovascular deaths of which 5.1% related to #COVID19, & an excess acute cardiovascular mortality of 2085 (+8%).
The greatest cause of excess cardiovascular death in care homes & hospices was #stroke (715, +39%), compared with ACS (#heartattack) (768, +41%) at home & cardiogenic shock (55, +15%) in #hospital.
This ‘displacement of death’, most likely, signifies that the public either did not seek help or were not referred to #hospital during the pandemic – a finding supported by the fact that the majority of acute #cardiovascular deaths were not recorded as due to #COVIDー19.
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Given the above times series plots show that the excess in acute #cardiovascular mortality began in late March 2020 & peaked in early April 2020, @GOVUK directives at the time including the onset of UK #lockdown on 23/3/20 could have accentuated a maladaptive public response.
That is, the excess #cardiovascular deaths began to emerge at the time the Government was promoting its ‘Stay at home, Protect the #NHS, Save lives’ messages.
Care homes & hospices witnessed a substantial increase in excess acute #cardiovascular deaths. This finding highlights the susceptibility of the elderly and co-morbid to the wider implications of COVID-19 crisis.
That is, not only were #carehome residents prone to the respiratory effects of #COVIDー19 infection, but they will also have been exposed to the acute #cardiovascular complications of COVID-19 & decisions not to go to #hospital for fear of becoming infected.
This situation will have been exacerbated by the discharge of unknowingly infected patients from #hospitals to #carehomes, a lack of systematic testing, the efficient person-to-person transmission of the virus, & its propensity to death in the vulnerable.
Through the systematic classification of all adult deaths in England & Wales, it is possible to show there has been an excess in acute #cardiovascular mortality during #CovidUK , seen greatest in the community & corresponds to public messaging & decline in admissions to hospital.
... & 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
“It is entirely plausible that a number of deaths could have been prevented if people had attended #hospital quickly when they began to experience their #heartattack or #stroke.”
“... people who died at home were most likely to have had a #heartattack. This is further support for the speculation that many people were staying away from #hospital even though they were very ill with an acute #cardiovascular illness.”
“The sad irony is that previous research we have undertaken showed that nationwide #heartattack services remained fully operational & continued to deliver high quality care during the peak of the [#COVID19] pandemic.”
As the #NHS prepares for another wave of #COVID19, we need to ensure people understand that #hospitals are open & have processes in place to minimise the risks of patients becoming infected.” @NHSEngland @BritishCardioSo @BSHeartFailure @BCIS_uk @BcsPresident @TheBHF @PHE_uk
The investigation was carried out by a team of #data scientists & clinicians, led by academics @UniversityLeeds @LeedsHospitals @LeedsMedHealth @UoL_LICAMM @LIDA_UK . The other collaborators were from @mmamas1973 @DrShingKwok @tomdenwood @NHSDigital @ONS @CardiacAudit
The article is freely available here @Heart_BMJ: Place and causes of acute cardiovascular mortality during the COVID-19 pandemic heart.bmj.com/content/early/…

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More from @cpgale3

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
Sep 18, 2020
This cluster randomised controlled trial found that opportunistic screening in primary care did not increase the detection of #AFib compared with usual care in patients aged 65 & over @bmj_latest bmj.com/content/370/bm…
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Yet the findings are in contrast to the SAFE study which showed that opportunistic screening for #atrialfibrillation over a year detected more new diagnoses than usual care.
Read 8 tweets

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