Paper information
- Authors
-
- Alex Walker,
- John Tazare,
- George Hickman,
- Christopher Rentsch,
- Elizabeth Williamson,
- Krishnan Bhaskaran,
- Dave Evans,
- Kevin Wing,
- Rohini Mathur,
- Angel Wong,
- Anna Schultze,
- Seb Bacon,
- Chris Bates,
- Caroline Morton,
- Helen Curtis,
- Emily Nightingale,
- Helen McDonald,
- Amir Mehrkar,
- Peter Inglesby,
- Brian MacKenna,
- Jonathan Cockburn,
- Will Hulme,
- Harriet Forbes,
- Caroline Minassian,
- Richard Croker,
- John Parry,
- Frank Hester,
- Sam Harper,
- Rosalind Eggo,
- Stephen Evans,
- Liam Smeeth,
- Ian Douglas,
- Laurie Tomlinson,
- Ben Goldacre
- Citation
- Walker et al. Changes in the rate of cardiometabolic and pulmonary events during the COVID-19 pandemic. medRxiv 2021.02.17.21251812; doi: https://doi.org/10.1101/2021.02.17.21251812
- Categories
Abstract
Background
There has been extensive speculation about the relationship between COVID-19 and various cardiometabolic and pulmonary conditions. This a complex question: COVID-19 may cause a cardiometabolic or respiratory event; admission for a clinical event may result in hospital-acquired SARS-CoV-2 infection; both may contribute to a patient surpassing the threshold for presenting to services; and the presence of a pandemic may change whether patients present to services at all. To inform analysis of these questions, we set out to describe the overall rate of various key clinical events over time, and their relationship with COVID-19.
Methods
Working on behalf of NHS England, we used data from the OpenSAFELY platform containing data from approximately 40% of the population of England. We selected the whole adult population of 17m patients and within this identified two further mutually exclusive groups: patients who tested positive for SARS-CoV-2 in the community; and patients hospitalised with COVID-19. We report counts of death, DVT, PE, ischaemic stroke, MI, heart failure, AKI and diabetic ketoacidosis in each month between February 2019 and October 2020 within each of: the general population, community SARS-CoV-2 cases, and hospitalised patients with COVID-19. Outcome events were defined using hospitalisations, GP records and cause of death data.
Results
For all outcomes except death there was a lower count of events in April 2020 compared to April 2019. For most outcomes the minimum count of events was in April 2020, where the decrease compared to April 2019 in events ranged from 5.9% (PE) to 40.0% (heart failure). Despite hospitalised COVID-19 patients making up just 0.14% of the population in April 2020, these patients accounted for an extremely high proportion of cardiometabolic and respiratory events in that month (range of proportions 10.3% (DVT) to 33.5% (AKI)).
Interpretation
We observed a substantial drop in the incidence of cardiometabolic and pulmonary events in the non-COVID-19 general population, but high occurrence of COVID-19 among patients with these events. Shortcomings in routine NHS secondary care data, especially around the timing and order of events, make causal interpretations challenging. We caution that the intermediate findings reported here should be used to inform the design and interpretation of any studies using a general population comparator to evaluate the relationship between COVID-19 and other clinical events.