A new study reveals the number of excess cardiovascular deaths during the first peak of the pandemic in England and Wales.

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New research looks at the number of excess deaths caused by cardiovascular disease in England and Wales during the first peak of the COVID-19 pandemic in the United Kingdom.

The results suggest a significant number of people did not go to hospital despite experiencing acute cardiovascular events, such as a stroke or a heart attack.

The research, which appears in the journal Heart, also provides information for governments on communicating with the public during a pandemic.

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As noted by the lead author of the study, Dr. Jianhua Wu, Associate Professor in the School of Medicine at the University of Leeds:

“This study is the first to give a detailed and comprehensive picture of what was happening to people who were acutely ill with cardiovascular disease across England and Wales. It reveals a large number of excess deaths. The findings will help [the] Government and the NHS [National Health Service] develop messages that ensure people who are very ill seek help.”

According to the Centers for Disease Control and Prevention (CDC), cardiovascular diseases — a collective name for conditions that primarily affect the heart or blood vessels — are the number one cause of disability and death worldwide.

In the context of the COVID-19 pandemic, it has become clear that cardiovascular diseases are a key underlying condition associated with an increased likelihood of death after contracting COVID-19.

At the same time, previous research has found a significant decrease in the number of people attending hospital following an acute cardiovascular event during the pandemic.

Therefore, it seems likely there would be an increase of deaths associated with cardiovascular disease beyond the expected figures, unless for some reason cardiovascular events reduced during the pandemic.

To understand the effects of this reduction in hospital admissions of people with cardiovascular disease, the present study authors compared information on cardiovascular mortality in England and Wales from the years before the pandemic with data collected during the pandemic.

They sourced this information from death certificates, which are filled in by the last doctor to attend a person within 5 days of their final illness, and record the location and cause of death.

From January 1, 2014 to June 30, 2020, there were death certificates for 3,450,381 people in England and Wales. Of these deaths, 17% were related to cardiovascular diseases.

From the first recorded COVID-19 death in the U.K. on March 2, 2020 until June 30, 2020, there were 28,969 recorded cardiovascular deaths.

By looking at the same period in the previous 6 years, the researchers were able to identify a baseline of expected cardiovascular deaths.

The researchers found there were 2,085 excess cardiovascular deaths from March 2 to June 30 — an increase of 8% “compared with the expected historical average in the same period of the year,” according to the study paper.

These deaths peaked in early April, coinciding with the government message, “Stay at home, Protect the NHS, Save lives.”

The researchers also noted a change in where people were dying.

Fewer people were dying in hospital — 53.4%, compared to the previous average of 63% — and more of these deaths were occurring at home or in care homes: increases of 23.5% to 30.9%, and 13.5% to 15.7%, respectively.

The main causes of death also differed depending on location. At home, the leading cause was heart attack or heart failure, in a care home it was stroke or heart failure, while in the hospital it was pulmonary embolism and cardiogenic shock.

For the study’s corresponding author Prof. Chris Gale, who teaches cardiovascular medicine at the University of Leeds, the “study reveals that people who died at home were most likely to have had a heart attack.”

“This is further support for the speculation that many people were staying away from the hospital even though they were very ill with an acute cardiovascular illness,” Prof. Gale adds.

“The reality of an untreated heart attack is that it will cause complications — and that will either lead to death, heart failure, or life-threatening heart rhythms.”

Despite this, Prof. Gale still believes encouraging people to stay at home was necessary: “The messages that went out at the time of lockdown were important. The NHS did need protecting from a potential surge of COVID-19 cases. But 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.”

“As the NHS prepares for any future wave of COVID-19, it needs to ensure people clearly understand that hospitals are open and have processes in place to minimize the risks of patients becoming infected with COVID-19,” he points out.

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