U.K. hospital admission rates for cardiovascular emergencies suggest patients are “fearful” of seeking medical help during the COVID-19 pandemic, with the most dramatic drop-offs seemingly in line with harsher social mandates and rising infection rates.
This is according to a University of Leeds analysis of national databases supervised by Chris Gale, PhD, and published online Tuesday in a letter to the Journal of the American College of Cardiology.
The authors stressed that clear public messaging is needed “to prevent further unintended consequences of social distancing mandates.”
The U.K. findings follow similar ones in other countries, such as the U.S., where National Center for Health Statistics (NCHS) data published earlier this month showed dramatic drop-off in patient numbers attending hospitals for cardiovascular conditions.
Researchers had previously recorded falling admission rates for acute coronary syndromes in the U.K. during the first wave of the pandemic, noted the letter, written by first author Jianhua Wu, PhD, and others, on which Gale was the senior author.
Wu and colleagues added that it was not clear whether broad news coverage of this trend in acute coronary syndrome hospital admissions during the pandemic’s first wave might prompt a change during any later government-mandated restrictions.
The research group studied daily incidence of admissions with heart failure (HF) and myocardial infarction (MI) among adults in the National Heart Failure Audit and (NHFA) Myocardial Ischaemia National Audit Project (MINAP) domains within the National Institute for Cardiovascular Outcomes Research (NICOR) databank.
The analysis period runs between November 1, 2018, and November 17, 2020, and includes data only from “rapid reporting hospitals” (22 in NHFA and 42 in MINAP) to avoid data reporting lag. A total of 62,683 admissions with HF and MI were recorded for the rapid reporting hospitals.
Wu and colleagues found a 54% drop in daily incidence of admissions in HF (incident rate ratio [IRR]: 0.46; 95% confidence interval [CI]: 0.41 to 0.51) compared to pre-pandemic times, and a 32% fall in MI admissions percentage (IRR: 0.68; 95% CI: 0.65 to 0.73) beginning March 23, 2020 – when the first UK lockdown occurred.
The biggest drop – the nadir – came on April 2 for HF and April 4 for MI.
The numbers recovered somewhat over the summer, as restrictions eased, with peak recovery up to 95% (IRR: 0.95; 95% CI: 0.91 to 0.99) of the pre-pandemic era on June 16 for HF, and by 93% (IRR: 0.93; 95% CI: 0.90 to 0.95) for MI on June 29.
However, the research group found that, from the beginning of October 2020 – prior to a second national lockdown being announced on October 31 – there was a second decline in admissions by 41% for HF (IRR: 0.59; 95% CI: 0.54 to 0.64) and by 34% for MI (IRR: 0.66; 95% CI: 0.63 to 0.69) through November 17, 2020, compared with the pre–COVID-19 period.
“As a comparison, there was little variation in admissions with HF and MI in the baseline year between 2018 and 2019,” the research group noted.
“The second dip appears of similar magnitude to that of the first and signals that the public are fearful of attending hospitals despite having medical emergencies, and that this varies over time—possibly relating to numbers of cases and social mandates,” they said.
In an accompanying statement published online the same day by the American College of Cardiology (ACC) press office, Gale said the data suggest a “re-run of one of the preventable tragedies of the first wave,” when patients were either too afraid to go to hospital or were not referred for treatment.
“The message to patients needs to be clear. If they experience symptoms of a heart attack or acute heart failure, they need to attend hospital. These are unforgiving medical emergencies. With the right help, people can recover from them. But if patients delay or avoid treatment, their will suffer life-limiting complications – or they will die.”
Wu, who led the analysis, added that one of the most worrying aspects of the research is that the decline in admissions seen since October “may not yet have bottomed out.” In the letter, the researchers add that because the period cohort for this analysis cannot determine a nadir in admissions, rates of admissions may decline further.
Simon Ray, MD, the president of the British Cardiovascular Society, added, “This research illustrates again the importance of the message that other medical problems don’t stop because of COVID.”
Wu J, Mamas MA, de Belder MA, et al. Second Decline in Admissions With Heart Failure and Myocardial Infarction During the COVID-19 Pandemic. J Am Coll Cardiol 2021 Jan 19. doi: 10.1016/j.jacc.2020.12.039