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Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality

Mohamed, Mohamed O; Banerjee, Amitava; Clarke, Sarah; de Belder, Mark; Patwala, Ashish; Goodwin, Andrew T; Shing Kwok, Chun; Rashid, Muhammad; Gale, Chris P; Curzen, Nick; Mamas, Mamas

Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality Thumbnail


Mohamed O Mohamed

Amitava Banerjee

Sarah Clarke

Mark de Belder

Ashish Patwala

Andrew T Goodwin

Chun Shing Kwok

Chris P Gale

Nick Curzen


Background: Limited data exists on the impact of COVID-19 on national changes in cardiac procedure activity, including patient characteristics and clinical outcomes before and during the COVID-19 pandemic.

Methods and Results: All major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression was performed to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period. Overall, there was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018-2019. Cardiac catheterisation and device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) whereas surgical procedures such as MVR, other valve replacement/repair, ASD/VSD repair and CABG were the most affected as a relative percentage difference (?) to previous years’ averages. TAVR was the least affected (?-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07-1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15-1.58, p<0.001).

Conclusion: Cardiac procedural activity has significantly declined across England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures, without an increase in risk of mortality for most cardiac procedures performed during the pandemic. Major restructuring of cardiac services is necessary to deal with this deficit, which would inevitably impact longterm morbidity and mortality.

Journal Article Type Article
Acceptance Date Oct 5, 2020
Online Publication Date Oct 20, 2020
Publication Date 2021-07
Publicly Available Date May 26, 2023
Journal European Heart Journal - Quality of Care and Clinical Outcomes
Print ISSN 2058-5225
Electronic ISSN 2058-1742
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 7
Issue 3
Pages 247-256
Keywords COVID-19, Procedures, Cardiac, England, Mortality
Publisher URL