Place and causes of acute cardiovascular mortality during the COVID-19 pandemic
Place and causes of acute cardiovascular mortality during the COVID-19 pandemic
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DOI：
10.1136/heartjnl-2020-317912
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发表时间：
2021-01-01
期刊：
影响因子：
5.7
通讯作者：
Gale, Chris P.
中科院分区：
文献类型：
--
作者：
Wu, Jianhua;Mamas, Mamas A.;Gale, Chris P.
目的 描述 COVID-19 大流行期间急性心血管死亡的地点和原因。方法 2014 年 1 月 1 日至 2020 年 6 月 30 日期间，英格兰和威尔士成人（年龄 >= 18 岁）急性心血管死亡 (n=5 87 225) 的回顾性队列。暴露的是 COVID-19 大流行（从 3 月 2 日英格兰首例 COVID-19 死亡开始） 2020）。主要结局是直接导致死亡的急性心血管事件。结果 2020 年 3 月 2 日后，共有 28 969 例急性心血管死亡，其中 5.1% 与 COVID-19 相关，急性心血管死亡率超额达到 2085 例（+8%）。社区死亡人数占这一时期所有死亡人数的近一半。在家中死亡的超额急性心血管死亡人数最多（2279 人，+35%），其次是疗养院和临终关怀中心（1095 人，+32%）和医院死亡（50 人，+0%）。这一时期急性心血管死亡最常见的原因是脑卒中（10 318例，35.6%），其次是急性冠脉综合征（ACS）（7 098例，24.5%）、心力衰竭（6 770例，23.4%）、肺栓塞（2 689例，9.3%）和心脏骤停（1 328例，4.6%）。疗养院和临终关怀中心过度心血管死亡的最大原因是中风（715 例，+39%），而在家中的 ACS（768 例，+41%）和医院的心源性休克（55 例，+15%）。结论和相关性 COVID-19 大流行导致急性心血管死亡人数激增，其中近一半发生在社区，而且大多数与 COVID-19 感染表明寻求帮助出现延误，或者可能是未确诊的 COVID-19 造成的。
Objective To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.Methods Retrospective cohort of adult (age >= 18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death.Results After 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.Conclusions and relevance The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.