Excess cardiac mortality due to reduced attendance at emergency departments during the pandemic

A study estimates the impact of reduced emergency department attendance on cardiac mortality in England during the early COVID-19 pandemic.

In the early stage of the pandemic, we observed a decline in patient visits to Emergency Departments (ED), including those for cardiac diseases. This decline may have been due to fear of coronavirus infection when attending hospital, public reluctance to overload National Health Service facilities, or difficulty accessing care. In our study, we tried to estimate the impact of reduced ED visits on cardiac mortality in England. We used data from ED visits from the Public Health England Emergency Department Syndromic Surveillance System (EDSSS). For cardiovascular disease outcomes, we obtained mortality counts for cardiac disease from the Office of National Statistics (ONS) for England. During the initial COVID-19 pandemic period (3/12/20-4/15/20), we observed a decline of 2750 ED visits per week for suspected cardiac disease (~35% decrease compared to the average weekly admission before the pandemic this year). When assuming a lag period of 18 days between non-presentation and the associated mortality, we estimated that for every 12 people with symptoms of heart disease, who didn’t visit the emergency departments, one of them died. We estimated that up to 232 cardiac deaths per week could have been prevented or delayed, had patients with heart disease symptoms attended hospital. However, there is some uncertainty regarding these estimates, due to the nature of the data and the method’s assumptions For more details, see ahajournals.org/doi/pdf/10.1161/CIRCOUTCOMES.120.007085