Place and causes of acute cardiovascular mortality during the COVID-19 pandemic.

Abstract

Objective. To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.
Methods. Retrospective cohort of adult (age =18 years) acute cardiovascular deaths (n=587,225) in England and Wales, 1st January 2014 to 30th June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2nd March 2020). The main outcome was acute cardiovascular events directly contributing to death.
Results. After 2nd March 2020, there were 28,969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10,318, 35.6%), followed by acute coronary syndrome (ACS) (7,098, 24.5%), heart failure (6,770, 23.4%), pulmonary embolism (2,689, 9.3%) and cardiac arrest (1,328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.
Conclusions and relevance. The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.