Nadarajah, R, Wu, J, Hurdus, B, Asma, S, Bhatt, DL, Biondi-Zoccai, G, Mehta, LS, Ram, CVS, Ribeiro, ALP, Van Spall, HGC, Deanfield, JE, Lüscher, TF, Mamas, MA and Gale, CP (2022) The collateral damage of COVID-19 on cardiovascular services: a meta-analysis. European Heart Journal. ISSN 0195-668X

[thumbnail of Re-Revision_Manuscript_Covid_20220404.docx] Text
Re-Revision_Manuscript_Covid_20220404.docx - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (160kB)


Aims The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic.

Methods From January 2019 to December 2021, Medline and Embase databases were searched for observational studies corn- and results paring a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% Cl 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave.

Conclusions There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.

Item Type: Article
Additional Information: The final version of this article and all relevant information related to it, including copyrights, can be found on the publisher website.
Uncontrolled Keywords: Cardiovascular; COVID-19; Hospitalization; Mortality; Treatment
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 01 Jun 2022 10:40
Last Modified: 04 Apr 2023 01:30

Actions (login required)

View Item
View Item