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Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis.

Authors
  • Cannata, Antonio1, 2
  • Watson, Samuel A1, 2
  • Daniel, Allen2
  • Giacca, Mauro1
  • Shah, Ajay M1
  • McDonagh, Theresa A2
  • Scott, Paul A2
  • Bromage, Daniel I1, 2
  • 1 School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.
  • 2 Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
Type
Published Article
Journal
European Journal of Preventive Cardiology
Publisher
SAGE Publications
Publication Date
May 27, 2022
Volume
29
Issue
8
Pages
1266–1274
Identifiers
DOI: 10.1093/eurjpc/zwab119
PMID: 34297822
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20-2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43-3.10) vs. 1.21 (95% CI 1.07-1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection. © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

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