Excess Cardiac Deaths from Avoiding Emergency Departments Remain a Cause for Concern

This article originally appeared on PracticalCardiology.com.

Tom Lumbers, PhD

New research from the University College of London Institute of Health Informatics is providing clinicians with an estimate of the excess cardiac deaths that occurred as a result of avoiding emergency departments during the peak of the coronavirus disease 2019 (COVID-19) pandemic.

While many cardiologists feared these events were still taking place, despite the declines in visits, the new data suggests excess cardiac deaths from avoiding visits during the pandemic could have been as high as 232 per week.

"These results provide evidence of the stark indirect effects of the COVID-19 pandemic on mortality in England,” said senior investigator Tom Lumbers, of the UCL Institute of Health Informatics, in a statement. “There is a need to better understand how the pandemic response resulted in a decline in attendance to EDs with suspected cardiac disease and other serious medical conditions to inform future strategies to mitigate both the direct and indirect effects of the pandemic."

With declines in emergency department visits being reported across the globe in 2020, investigators sought to further describe how this apparent drop may have impacted the cardiac mortality of patients in England. To do so, investigators designed their study to quantify the change in daily visits for suspected cardiovascular disease and compare it to the rate of cardiac mortality from the same period using a two-stage least squares method.

For daily emergency department visits, investigators pulled data from 60 hospitals within the Public Health England Emergency Department Syndromic Surveillance System weekly bulletins. Cardiac deaths were identified through the use of ICD-10 codes. For the purpose of the analysis, the COVID-19 pandemic period was defined as March 12, 2020-April 15, 2020.

During that time period, investigators noted a decline of 2750 (95%CI, 2504-2996) visits per week, which represents a 35% decrease compared to average weekly admission rates before the pandemic in 2020. Based on data from their analysis, investigators estimated between 3.1 (95% CI, 1.5-4.6) and 8.4 (95% CI, 7.0-9.8) excess cardiac deaths.

Additionally, the weekly excess cardiac mortality due to nonattendance was estimated to be between 84 (95% CI, 42-127) and 232 (95% CI, 193-270) deaths. Further analysis indicated the increase in weekly. Cardiac mortality of up to 18% compared to the previous 5 years.

"The public health messaging to protect the NHS may have led to patients not attending ED out of fear or public-mindedness or difficulty accessing services due to the pandemic,” added Lumbers. “Our results suggest that the pandemic response may have led to the undertreatment of non-COVID-19 diseases, including heart conditions, with important impacts on the excess mortality observed during this period."

This study, “Estimating the Effect of Reduced Attendance at Emergency Departments for Suspected Cardiac Conditions on Cardiac Mortality During the COVID-19 Pandemic,” was published in Circulation Cardiovascular Quality and Outcomes.