Researchers at LIDA have been at the forefront of an academic collaboration to monitor the impact of Covid-19 on emergency cardiac services, morbidity and mortality rates.
On 23rd March as the UK went into lockdown, the NHS had to change. But getting insight into what was happening to patients as the NHS reorganised services to focus on Covid-19 wasn’t happening. Governance, security and bureaucracy meant that access to this patient data was not available, and this had unforeseen consequences on hospital admissions, treatment and death rates in the UK. Cardiovascular patients in particular were at risk. Government gave the team special permission to access the data and the team’s remit, endorsed by Sir Patrick Vallance, the Government Chief Scientific Adviser, was to use national datasets to rigorously examine and interpret the full effects of the pandemic and provide rapid information through to the government’s Scientific Advisory Group for Emergencies (SAGE) (chaired by Sir Patrick Vallance) and to NHS England (through the National Clinical Director for Heart Disease, Professor Nick Linker).
The LIDA team, led by Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds and Dr Jianhua Wu, Associate Professor in Biostatistics at the University of Leeds, worked closely with NHS Digital (the national information and technology partner to the health and care system), the National Institute for Cardiovascular Outcomes Research (NICOR), Hospital Episodes Statistics (HES) data, and other academics from Keele, UCL, Manchester and Oxford Universities to provide a secure remote data access environment to accommodate a live-feed national database for analysis. This meant they could access and link across several national databases in a short period of time and quickly analyse the impacts of the COVID-19 pandemic using contemporary data, both in terms of understanding the relationship between Cardiovascular Disease and COVID-19 outcomes and also the effects of changes to the delivery and take-up of NHS CVD services.
Initial analysis has focussed on the impact of the pandemic on admissions to hospital, the quality of the delivery of care and survival after heart attacks.
The team analysed admission data for 50,689 patients who had a heart attack and were treated at 99 NHS hospitals over the 14 months prior to lockdown, and the same data for the first two months of lockdown. They found that during COVID-19 there was an unintended consequence of the stay at home messaging – significantly fewer people were attending hospital with a heart attack. 49% fewer people with a partial blockage of one of the blood vessels (known as a NSTEMI heart attack) attended hospital, and 29% fewer people with a full blockage STEMI heart attack attended hospital. Patients who did present to hospital were younger, less co-morbid, and for NSTEMI, had higher 30-day mortality. Yet, despite this substantial drop in admissions NHS care was found to be excellent.
The team also analysed ONS civil registration deaths for England and Wales and found that that the COVID-19 pandemic has resulted in an increase in acute cardiovascular deaths, nearly half of which occurred in the community, and most did not relate to COVID-19 infection.
This project has used rapid national data on Cardiovascular Disease (CVD) in an emergency setting to inform immediate government and NHS policy, improve patient care and save lives. It has informed guidance on pandemic planning and has far reaching impact for a potential second wave of Covid-19.
14 papers have so far been published, including in the Lancet, one of the highest impact journals in the world. More research is due to be published including CVD death data for England and Wales. This patient level data shows how things have changed whilst the world has been reeling from Covid-19 – reduced admissions, high levels of care and huge impact in deaths from cardiovascular disease. It has already informed planning for a potential second wave with the British Cardiac Society (body for all of cardiology in UK) aiming to keep cardiac operations open.
This work has also transformed the information governance landscape by creating a linked ‘cardiovascular data spine’. This has enabled data to be collated and analysed rapidly to inform Government and NHS policy now and in the future.
“The data have given us a very detailed picture of the way patient behaviours changed as Covid-19 swept across Europe”. Dr. Jianhua Wu says this was an unintended consequence of the “stay at home” messaging. He added that the message has been heard by NHS advisors, citing the Chief Medical Officer (CMO) for England, the UK government’s Chief Medical Adviser and head of the public health profession, Chris Witty who has said that the ‘NHS is open for business.’
Prof Gale, senior author of the study says this research “has shown the devastating impact that the pandemic has had on people’s lives’ and believes that the inflation of deaths among people attending hospital with a heart attack is likely to be an early signal of even greater mortality and morbidity yet to be observed.”
“A heart attack is a medical emergency, and if people do not seek medical help, they either die or go on to develop heart failure. We need to make sure that people are aware that emergency services continue to operate and the NHS now needs to be ready to support those who do not attend hospital and therefore require long term support for their heart condition.” added Professor Gale.
The University of Leeds is collating the data on the impact of COVID-19 regularly so they can be shared with other researchers and the public. The data can be accessed at: https://cardiovascularcovid.leeds.ac.uk/
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