COVID-19 has become a leading cause of death worldwide, disproportionately affecting people with cardiovascular disease. Work to understand global changes in the burden of cardiovascular disease because of COVID-19 found reductions in health facility admissions for cardiovascular disease and variability across countries for the rates of mortality at the hospital and populations levels in 2020. The State-of-the-Art review was published on Aug. 1 in the Journal of the American College of Cardiology.

As part of the ongoing Global Burden of Disease (GBD)-National Heart, Lung, and Blood Institute-Journal of the American College of Cardiology Global Burden of CVD Collaboration, the review examined current evidence for the consequences of COVID-19 for population-level changes in cardiovascular disease.

Gregory A. Roth, MD, MPH, FACC, et al., used data from the GBD to analyze the cause of death reported in death certificates since 2020 in countries to determine whether there was an excess compared with previous years. They also conducted a structured literature search of multicenter studies of cardiovascular disease-related health care delivery, health facility admission or visit, and mortality in-hospital and in the population.

The GBD data showed that the number of deaths coded to cardiovascular disease as the underlying cause was similar or even lower in 2020 for most countries when compared with the average of the five previous years, except in Ecuador (up 50%), Mexico (up 35%) and Russia (up 7%). In Sweden, CVD deaths were 7.5% lower in 2020 compared with previous years. The authors note that the degree of misclassification of death due to COVID-19 as due to cardiovascular disease is unclear.

Data from the literature review showed a decrease in health care delivery in many countries due to lockdown policies and health systems shifting to build capacity for COVID-19 patients. For example, substantial decreases were seen in England for PCI, TAVR and surgical aortic valve replacement. Admissions or visits for cardiovascular disease decreased significantly. In Japan, heart failure (HF) hospitalizations declined 3.6% per week; in Chile, new diagnoses for stroke and MI were decreased; and in Italy, the Lazio and Rome region had a nearly 70% decline in STEMI admissions, while in the Bologna region had a 58% reduction in emergency department visits for cardiovascular causes and a 10% decline in related admissions.

When looking at mortality in hospital, the literature review found more variability. No change was seen in 2020 for in-hospital mortality for HF in Japan and the U.S., but an increase from 5.5.% to 7% in Germany. In Denmark, an 8% decrease was found for all cardiovascular disease-related deaths.

Similarly, population mortality for cardiovascular disease varied, ranging from decreases to large increases during the first year of the pandemic. For instance, during the first 10 months of the pandemic in the U.S., there was a more rapid rise in deaths from ischemic heart disease and hypertensive disease, but no change for deaths from HF, cerebrovascular causes or other circulatory deaths.

“Taken together, these studies suggest heterogenous effects of the COVID-19 pandemic on [cardiovascular disease] burden,” write the authors. They note that “changes observed in cardiovascular disease burden during the COVID-19 pandemic provide unique opportunities for basic, clinical, and population science research to address the possibility of direct or indirect COVID-19 and SARS-CoV-2–related changes in cardiovascular disease event rates.”

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Acute Heart Failure, Interventions and Vascular Medicine, Hypertension, Chronic Angina

Keywords: Policy, Emergency Service, Hospital, Stroke, Hypertension, Heart Failure, Hospitalization, Transcatheter Aortic Valve Replacement, ST Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Capacity Building, Aortic Valve, Hospital Mortality, Pandemics, Hospitals, Cardiology, Health Facilities, Delivery of Health Care, Death Certificates, SARS-CoV-2, COVID-19, Cardiovascular Diseases, Global Burden of Disease, United States

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