Clinical Care for CVD in the COVID-19 emergency

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Hospital statistics

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Clinical Care for CVD in the COVID-19 emergency

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Definitions

A&E attendance with cardiac conditions: A&E diagnosis code 20

Admission with ACS: ICD-10 codes I21-24

Admission with heart failure: ICD-10 codes I50

PCI performed: OPCS-4 codes K49, K50, K75

Cardiac pacemaker & resynchronisation: OPCS-4 codes K59-60

CABG performed: OPCS-4 codes K40-44

Cardiovascular statistics

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Clinical Care for CVD in the COVID-19 emergency

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Definitions

A&E attendance with cerebrovascular conditions: A&E diagnosis code 21

Admission with acute stroke/TIA: ICD-10 codes I60-61, I63-64, G45

Stroke thrombolysis and thrombectomy : OPCS-4 code X83.3 and ICD-10 code I63 for IV thrombolysis; OPCS-4 code (v.4.9) 35.4 or combination of OPCS-4 codes (v4.8) L71.2 + Y53 + Z35 + ICD-10 code I63 for thrombectomy

Cerebral aneurysm coiling: OPCS-4 codes O01-04 + Y53 + Z53

Cerebrovascular statistics

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Clinical Care for CVD in the COVID-19 emergency

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Definitions

A&E attendance with vascular conditions: A&E diagnosis code 22

Admission with aortic aneurysms: ICD-10 code I71

Admission with DVT or PE : ICD-10 codes I26, I80

Carotid endarterectomy / stenting: OPCS-4 codes L29.4, L29.5, L31.4

Limb revascularisation, bypass or amputation: OPCS-4 codes L48-54, L56-63, L16-65, X09-11

Aortic aneurysm repair: OPCS-4 codes L18-23, L25-28

Peripheral angioplasty: OPCS-4 codes L54-71

Vascular statistics

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Clinical Care for CVD in the COVID-19 emergency

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Note that some hospital activities have low numbers witin individual hospitals. Small absolute change in these numbers can give large percentage changes. Please consider this when interpreting this table. For data governance, we do not provide raw counts.

Clinical Care for CVD in the COVID-19 emergency

Authors

4C Initiative of the CVD-COVID-UK consortium

Authors listed alphabetically: S Ball, A Banerjee, C Berry, J Boyle, B Bray, W Bradlow, A Chaudhry, R Crawley, J Danesh, A Denniston, F Falter, JD Figueroa, C Hall, H Hemingway, E Jefferson, T Johnson, G King, K Lee, P McKean, SM Mason, N Mills, E Pearson, M Pirmohamed, MTC Poon, R Priedon, A Shah, R Sofat, J Sterne, F Strachan, CLM Sudlow, Z Szarka, W Whiteley, M Wyatt

App development

This web application is developed by Michael Poon . Source code is available on GitHub . For queries about this web application or suggestions for additional functionalities, please contact mpoon@ed.ac.uk .

Abstract

The 4C Initiative (Clinical Care for Cardiovascular disease in the COVID-19 pandemic)

Monitoring the indirect impact of the coronavirus pandemic on services for cardiovascular diseases in the UK


Background: The coronavirus (COVID-19) pandemic affects cardiovascular diseases (CVDs) directly through infection and indirectly through health service reorganisation and public health policy. Real-time data are needed to quantify direct and indirect effects. We aimed to monitor hospital activity for presentation, diagnosis and treatment of CVDs during the pandemic to inform on indirect effects.

Methods: We analysed aggregate data on presentations, diagnoses and treatments or procedures for selected CVDs (acute coronary syndromes, heart failure, stroke and transient ischaemic attack, venous thromboembolism, peripheral arterial disease and aortic aneurysm) in UK hospitals before and during the COVID-19 epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends.

Findings: Nine hospitals across England and Scotland contributed hospital activity data from 28 Oct 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown), and for the same weeks during 2018-2019. Across all hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1-58.6%) and 52.9% (52.2-53.5%) respectively compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown, and fell by 31-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances RR 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020.

Interpretation: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.


Preprint will be available shortly.