Avoiding Emergency Departments Due to COVID-19 Caused Increase in Cardiovascular Deaths

Rishi Wadhera, MD

As clinicians and researchers across the nation worked to combat the ongoing pandemic, reports of COVID-19’s indirect impact on healthcare continued to grow and chief among these for cardiologists was the decline in patients presenting to emergency departments for cardiovascular conditions.

Now, a nationwide analysis of data from the Centers for Disease Control and Prevention (CDC) is offering insight into the number of deaths, specific causes, and what regions of the country were most adversely impacted by the indirect impact of COVID-19.

"Hospital visits for heart attacks and other cardiac conditions declined markedly during the pandemic, fueling physicians' concerns that people with acute conditions may be staying at home due to fear of exposure to COVID-19," said the study's corresponding author, Rishi K. Wadhera, MD, MPP, MPhil, a cardiologist and researcher at the Smith Center and Beth Israel Deaconess Medical Center, in a statement. "Our research raises concern that the avoidance of hospitals, deferral of semi-elective procedures and care, and substantial strain imposed on hospitals during the early phase of the pandemic may have had an indirect toll on patients with cardiovascular disease."

Noting the declines in emergency department visits for cardiovascular conditions throughout the pandemic, Wadhera and colleagues from Beth Israel Deaconess Medical Center sought to evaluate whether this decline was associated with an increase in cardiovascular deaths. With this in mind, investigators designed the current analysis as an observational cohort study using data from the CDC’s National Center for Health Statistics.

For the purpose of analysis, the study was designed to compare the rate of deaths due to cardiovascular causes from March 18, 2020-June 2, 2020 to the period immediately preceding the pandemic, which was defined as January 1, 2020-March 17, 2020. Specific causes of death were identified using ICD-10 codes for ischemic heart disease, heart failure, hypertensive diseases, cerebrovascular disease, and other diseases of the circulatory system.

From January 1, 2020-June 2, 2020, investigators identified a total of 397,042 deaths from cardiovascular causes. Of these, 199,311 occurred during the pre-pandemic period and 197,731 occurred during the pandemic period.

Results of the investigators’ analyses indicated deaths from ischemic heart disease began to increase nationally after the onset of the pandemic when compared against the same period in 2019 (ratio of the relative change in deaths per 100,000 in 2020 vs. 2019: 1.11; 95% CI, 1.04-1.18). Additionally, results indicated an apparent increaser in deaths caused by hypertensive disease (1.17; 95% CI, 1.09-1.26) but not for heart failure (0.97; 95% CI, 0.92-1.01), cerebrovascular disease (1.03; 95% CI, 0.99-1.07), or other diseases of the circulatory system (0.99; 95% CI, 0.95-1.04).

When assessing increases by location, investigators found the largest relative increased in deaths caused by ischemic heart disease occurred in New York City (2.39; 95% CI, 1.39-4.09). Investigators also noted increases in deaths caused by ischemic heart disease in New Jersey (1.45; 95% CI, 1.22-1.73), Michigan (1.23; 95% CI, 1.07-1.41), Illinois (1.11; 95% CI, 1.04-1.19), and the remainder of New York State (1.44; 95% CI, 1.16-1.79). Increases in deaths caused by hypertensive disease after the onset of the pandemic occurred in New York City (2.64; 95% CI, 1.52-4.56), New Jersey (1.88; 95% CI, 1.38-2.57), Michigan (1.16; 95% CI, 1.00-1.35), Illinois (1.30; 95% CI, 1.12-1.51), and the remainder of New York State (1.28; 95% CI, 1.06-1.55).

"Overall, our data highlight the urgent need to improve public health messaging and rapidly expand health care system resources to ensure that patients with emergent conditions seek and receive medical care—particularly in regions currently experiencing a sharp rise in COVID-19 cases," Wadhera said.

This study, “Cardiovascular Deaths During the COVID-19 Pandemic in the United States,” was published in the Journal of the American College of Cardiology