Amid pandemic, elective CVD admissions down, ED visits up in UK
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In the U.K., the severity of CVD comorbidities increased during the pandemic while elective admissions and procedures decreased, an observation accompanied by increased emergency admissions, researchers reported.
In 2021, elective admissions remained 15% lower compared with the pre-pandemic era and emergency admissions were up by 6%, driven by HF admission and stroke in England, and venous thromboembolism in England, Wales and Scotland, according to a study published in the European Heart Journal – Quality of Care & Clinical Outcomes.
“This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures,” F. Lucy Wright, BN, DPhil, senior epidemiologist in the unit of health care epidemiology at the Nuffield department of population health at the University of Oxford, and colleagues wrote. “This is likely to increase further the demands on cardiovascular services over the coming years.”
For the analysis of national electronic health record data for England, Scotland and Wales, Wright and colleagues utilized the CVD-COVID-UK/COVID-IMPACT consortium established for pandemic-related research. Researchers compared 1,973,104 admissions and 1,616,550 procedures from 2016 to 2019 with 970,374 admissions and 635,187 procedures from 2020 to 2021 to better understand the indirect impact of the pandemic on secondary prevention in the U.K.
CVDs of interest included ACS, HF, stroke/transient ischemic attack, peripheral artery disease, aortic aneurysm and VTE.
Researchers observed no significant difference in baseline characteristics of admissions or procedures across countries or CVDs by age, gender or ethnic group in the pre-pandemic era compared with 2020 and 2021. However, in England, the Charlson comorbidity profile was more severe during the pandemic compared with pre-pandemic era for all admissions and all procedures, except for ventricular assist device, cardiac transplant and pulmonary embolectomy, according to the study.
Compared with the pre-pandemic era, in 2020, there were approximately 6% fewer hospital admissions for each of the CVDs of interest, including 4% fewer emergency admissions and 23% fewer elective admissions.
Researchers observed that overall hospital admissions returned to pre-pandemic levels in 2021, but elective admissions remained 15% lower compared with the pre-pandemic era.
However, Wright and colleagues noted that the persistent reductions in elective admissions were offset by 6% more emergency admissions compared with the pre-pandemic era, an observation driven by HF admission and stroke in England, and VTE in all three countries studied.
“We now confirm previous reports of reduced activity for admissions and for PCI and other CVD-related procedures, showing variation by timing, speed and extent of recovery across subtypes,” the researchers wrote. “Given the significant backlogs across services in the U.K. and other countries, there is an urgent need to monitor and understand these indirect impacts of the COVID-19 pandemic, to develop coordinated, but tailored responses, based on subtype, type and urgency of care, and country. Without urgent action, indirect and long-term consequences could create far greater burden and cost to individuals, populations and health systems than acute, direct effects.”
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Wright FL, et al. Eur Heart J Qual Care Clin Outcomes. 2022;doi:10.1093/ehjqcco/qcac077/6831631.
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