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Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis

Research output: Contribution to journalArticlepeer-review

Antonio Cannata, Samuel A. Watson, Allen Daniel, Mauro Giacca, Ajay M. Shah, Theresa A. McDonagh, Paul A. Scott, Daniel I. Bromage

Original languageEnglish
Pages (from-to)1266-1274
Number of pages9
JournalEuropean journal of preventive cardiology
Issue number8
Published27 May 2022

Bibliographical note

Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

King's Authors


AIMS : The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. METHODS AND RESULTS : A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20-2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43-3.10) vs. 1.21 (95% CI 1.07-1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). CONCLUSIONS : In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.

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