Coronavirus and Heart & Circulatory Diseases Factsheet - Our vision is a world free from the fear of heart and circulatory diseases.

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Coronavirus and Heart & Circulatory Diseases Factsheet - Our vision is a world free from the fear of heart and circulatory diseases.
Coronavirus and
Heart & Circulatory
Diseases Factsheet
May 2021

Our vision is a world free from the
fear of heart and circulatory diseases.1
Heart & Circulatory Diseases (Cardiovascular Disease; CVD)
Heart and circulatory diseases is an umbrella term for all diseases of the heart and circulation – from
those that are inherited or that a person is born with, to those that are developed later, such as
coronary heart disease, atrial fibrillation, heart failure, stroke and vascular dementia.
•    There are around 7.6 million people living with heart and circulatory diseases in the UK - an ageing and growing population
     and improved survival rates from heart attacks and strokes, could see these numbers rise still further.

•    Normally in the UK there are an average of around 22,000 hospital admissions each week where a heart or circulatory disease
     is the main diagnosis, including 2,500 due to stroke and 2,000 due to a heart attack.

Coronavirus (COVID-19; SARS-CoV-2)
COVID-19 is a new illness that can affect your lungs and airways. It's caused by coronavirus.
•    The illness can affect anyone, and the experience can vary from asymptomatic (no symptoms) or mild, to critical and fatal.

•    Severe illness can cause widespread inflammation and affect the heart, blood pressure and other functions.

•    Because the virus is new, there’s a lot we don’t yet know. But thanks to research, we are learning quickly.

    For more information please visit the BHF website:

        What does coronavirus do to your body?

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Coronavirus and Heart & Circulatory Diseases
Here are some key statistics – for sources and references see pages 7-8.

•   International research suggests that people living with heart and circulatory (cardiovascular) diseases are at significantly
    increased risk of severe outcomes (3.9 times higher) and death (2.7) from Covid-19.

•   UK research shows increased coronavirus risk for people living with chronic heart disease, stroke and dementia, plus their
    risk factors (e.g. diabetes, obesity).

              Fig 1 - UK coronavirus mortality risk research

•   Research suggests that people with heart failure are at increased risk of mortality if infected with coronavirus.
                                                                                                                                   3
•   Evidence suggests that people with hypertension (high blood pressure) may be at greater risk of getting severely ill with
    COVID-19 - especially if uncontrolled or untreated.

•   The pandemic has highlighted health inequalities by age, gender and ethnicity and more research is required to understand
    these, including how heart and circulatory diseases and their risk factors affect Covid-19 risk and outcomes.

•   A study of severe Covid-19 cases in hospitals across the UK showed that chronic cardiac disease was the most common
    comorbidity [other conditions that someone has been diagnosed with, e.g. high blood pressure and diabetes].

•   A global study suggests that around half of heart scans from coronavirus patients in hospital show abnormalities, with one
    in seven showing severe abnormalities likely to impact on patients’ survival and recovery.

•   Around 9 out of 10 deaths in Great Britain that mention coronavirus also record a pre-existing health condition.

•   Coronary heart disease (CHD) is one of the most common pre-existing conditions for deaths involving coronavirus – others
    include dementia, cerebrovascular disease (stroke), hypertensive heart disease, diabetes and heart failure.

•   45 per cent of Covid-19 death certificates in England in Spring 2020 mentioned cardiovascular (heart/circulatory) disease.

                                                                                                                             800
     •   In just one week in April 2020, there were more than 700 excess deaths                                              700

                                                                                                          Number of excess
                                                                                                                                            Other
         from heart and circulatory diseases in England, including around 300 from coronary heart                            600            circulatory
                                                                                                                             500            diseases
         disease and nearly 200 from stroke.

                                                                                                             deaths
                                                                                                                             400            Stroke

     •   In the first year of the pandemic there were over 5,800 excess deaths from heart                                    300
         and circulatory diseases in England, some of which will also have included Covid-19 diagnoses.                      200            Coronary
                                                                                                                                            heart
                                                                                                                             100
                                                                                                                                            disease
    To read the full story, and to find out exactly what excess deaths means please read our blog post.                        0
                                                                                                                                    10 Apr 20
                                                                                                                                   Week ending            4
•   Data for out-of-hospital cardiac arrests (OHCAs) suggest that periods of high coronavirus transmission have led to
    increased OHCA volumes and lower survival rates.

•   Visits to accident and emergency (A&E) departments in England for suspected heart attacks dropped by around 50% in
    Spring 2020, suggesting that people in urgent need may have decided not to go to hospital.

•   BHF-funded research suggests that an estimated 5,000 heart attack sufferers in England may have missed out on life saving
    hospital treatment in Spring 2020 due to the Covid-19 pandemic.

•   The fall in the number of patients presenting to hospital in England & Wales with heart failure was even more marked than
    for heart attacks, dropping by two thirds (66 per cent) by the end of April 2020.

•   In Scotland, heart and circulatory A&E attendances in March and April 2020 were almost 60% lower
    (compared to the previous year)

    Fig 2 - A&E heart and circulatory attendances, Scotland

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•   Emergency cardiology admissions in Scotland declined by up to 40% during the pandemic.

•   Data from Scotland suggest that the proportion of heart attack deaths in the home increased during Spring 2020.

•   The pandemic has significantly reduced capacity for cardiac surgery and procedures, with thousands postponed or
    cancelled across the country.

•   NHS data show that nearly 220,000 people were waiting for investigations or treatment in cardiology or cardiothoracic
    surgery in England at the end of March 2021 - around 52,000 had been waiting longer than 18 weeks, and more than 5,200
    had been waiting for at least a year – up from just 28 at the end of February 2020.

•   There has been a dramatic increase in waiting times for diagnostic care in England, with tens of thousands of people
    waiting more than six weeks for an echocardiogram – Spring 2020 activity dropped to as low as one third of normal levels.

•   BHF-funded research aims to help understand “long Covid” – specifically the deadly link between Covid-19 and many heart
    and circulatory diseases, and to protect health against the damaging and potentially long-term effects of Covid-19.

COVID-19, research and the BHF
Blog by Professor Sir Nilesh Samani, Medical Director
BHF Coronavirus Hub – support and information

Compiled by the British Heart Foundation.
Reviewed and updated May 2021.
For any queries, contact us and we will do our best to help -
please mark for the attention of the Health Intelligence team.

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References
STATISTIC                                              REFERENCE

HEART AND CIRCULATORY DISEASES (CARDIOVASCULAR DISEASE; CVD) AND CORONAVIRUS (COVID-19)

7.6m living w/ heart/circulatory diseases   p2   BHF UK estimate based on latest Quality & Outcomes Framework prevalence data

Pre-pandemic hospital admissions data       p2   UK hospital statistics; NHS Digital/Public Health Scotland/NHS Wales/DH Northern Ireland

Cardiovascular risk and COVID-19            p3   Luo et al (2020) Clin Cardiol -The potential association between common comorbidities and severity and mortality of coronavirus disease
                                                 2019: a pooled analysis https://onlinelibrary.wiley.com/doi/10.1002/clc.23465

Mortality risk in hospitalised COVID-19     p3   The OpenSAFELY Collaborative (2020) Factors associated with COVID-19-related hospital death in the linked electronic health records of
patients; Fig 1                                  17 million adult NHS patients www.medrxiv.org/content/10.1101/2020.05.06.20092999v1
Obesity risk                                     Yang et al (2020) J Med Virol - Obesity aggravates COVID‐19 doi.org/10.1002/jmv.26237;
(additional references)                          Hussain et al (2020) Obesity and mortality of COVID19. www.sciencedirect.com/science/article/pii/S1871403X20305500

Heart failure risk & COVID-19               p3   Rey et al (2020) Eur J Heat Failure - Heart Failure In Covid‐19 Patients: Prevalence, Incidence And Prognostic Implications
                                                 onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.1990

Hypertension (high blood pressure) risk &   p4   Chao Gao et al (2020) Eur Heart J - Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective
COVID-19                                         observational study academic.oup.com/eurheartj/article/41/22/2058/5851436

Health inequalities and COVID-19            p4   ISARIC (2020) Ethnicity & Outcomes from COVID-19: ISARIC CCP-UK Prospective Observational Cohort Study of Hospitalised Patients
                                                 isaric.tghn.org/articles/ethnicity-and-outcomes-covid-19-isaric-ccp-uk-prospective-observational-cohort-study-hospitalised-patients

Hospital comorbidities –                    p4   Docherty et al (2020) BMJ - Features of 20 ,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation
most common in COVID-19 patients                 Protocol: prospective observational cohort study www.bmj.com/content/369/bmj.m1985

Heart scan abnormalities in COVID-19        p4   Dweck et al (2020) EHJ Cardiovascular Imaging - Global evaluation of echocardiography in patients with COVID-19
patients                                         https://academic.oup.com/ehjcimaging/article/doi/10.1093/ehjci/jeaa178/5859292
                                                 Sandoval et al (2020) ACC - Key points about myocardial injury and cardiac troponin in COVID-19
                                                 www.acc.org/latest-in-cardiology/articles/2020/07/17/08/00/key-points-about-myocardial-injury-and-cardiac-troponin-in-covid-19
                                                 also Kotecha et al (2021) EHJ https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab075/6140994

Pre-existing conditions in                  p4   Office for National Statistics (2020) Deaths involving COVID-19, England & Wales (Spring 2020 releases)
9 out of 10 COVID-19 deaths;                     www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths
CHD one of most common                           National Records of Scotland (2020) Deaths involving COVID-19, Scotland, pre-existing conditions analysis updated monthly around third
                                                 week of month (other mortality statistics are updated weekly) www.nrscotland.gov.uk/news

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STATISTIC                                    REFERENCE

HEART AND CIRCULATORY DISEASES (CARDIOVASCULAR DISEASE; CVD) AND CORONAVIRUS (COVID-19)

CVD (H&CD) mentions on COVID-19         p4   Public Health England (2020) Disparities in the risk and outcomes of COVID-19
death certificates, England                  www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes

Excess CVD mortality during pandemic,   p4   Public Health England (2021) Excess mortality in England: weekly reports to 26 Feb 2021
England; blog                                https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html

Out-of-hospital cardiac arrests         p5   Fothergill et al (2021) Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic
(OHCAs)                                      www.sciencedirect.com/science/article/pii/S2666520420300679
                                             NHS England (2021) Ambulance Quality Indicators - see Clinical Outcomes series
                                             www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/

English hospital A&E visits             p5   Public Health England (2020) Emergency department: weekly bulletins for 2020, weekly bulletin for 9 April 2020 (week 14)
                                             www.gov.uk/government/publications/emergency-department-weekly-bulletins-for-2020

England 5k heart attack (MI) patients   p5   Mafham et al (2020) Lancet - COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
                                             www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext
MI and heart failure admissions              Wu et al (2021) JACC - Second decline in admissions with heart failure and myocardial infarction during the COVID-19 pandemic
                                             https://www.sciencedirect.com/science/article/pii/S0735109720381961

England & Wales heart failure           p5   NICOR (2020) Rapid cardiovascular data: We need it now (and in the future) – based on Heart Failure Audit data
admissions                                   www.nicor.org.uk/wp-content/uploads/2020/09/NICOR-COVID-2020-Report-FINAL.pdf

Scottish A&E; admissions                p5   Public Health Scotland (2020) Cardiovascular A&E attendances and admissions scotland.shinyapps.io/phs-covid-wider-impact/

Scottish heart attack deaths/home       p5   BHF analysis of 2020 data from NRS (National Records of Scotland); BHF Scotland correspondence

delayed heart procedures;               p6   NHS England (2021) Consultant Led Referral-to-Treatment Waiting Times (Incomplete Pathways)
cardio waiting list England                  www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2020-21/
                                             Waiting lists are also published for Scotland, Wales and Northern Ireland, but criteria may not be directly comparable.

echo waiting times, England             p6   NHS England (2021) Monthly Diagnostics Data 2020-21 www.england.nhs.uk/statistics/statistical-work-areas/diagnostics-waiting-times-and-
                                             activity/monthly-diagnostics-waiting-times-and-activity/monthly-diagnostics-data-2020-21/ also published for Wales and Northern Ireland

long COVID research;                    p6   www.hdruk.ac.uk/news/research-begins-to-rapidly-understand-deadly-link-between-covid-19-and-cardiovascular-diseases/
prevalence                                   Office for National Statistics (2020) The prevalence of long COVID symptoms and COVID-19 complications
                                             www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications

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