Changes in the rate of cardiometabolic and pulmonary events during the COVID-19 pandemic

Walker, A. J.; Tazare, J.; Hickman, G.; Rentsch, C. T.; Williamson, E. J.; Bhaskaran, K.; Evans, D.; Wing, K.; Mathur, R.; Wong, A. Y.; Schultze, A.; Bacon, S. C.; Bates, C.; Morton, C. E.; Curtis, H. J.; Nightingale, E.; McDonald, H. I.; Mehrkar, A.; Inglesby, P.; MacKenna, B.; Cockburn, J.; Hulme, W. J.; Forbes, H.; Minassian, C.; Croker, R.; Parry, J.; Hester, F.; Harper, S.; Eggo, R. M.; Evans, S. J.; Smeeth, L.; Douglas, I. J.; Tomlinson, L.; Goldacre, B.

Background The COVID-19 pandemic is likely to influence the rate of cardiometabolic and pulmonary complications. We set out to measure the overall rate of events over time. 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 identified three mutually exclusive groups: hospitalised with COVID-19, tested positive for SARS-CoV-2, and everyone else. We then counted rates of death, DVT, PE, ischaemic stroke, MI, heart failure, AKI and diabetic ketoacidosis in each month between February 2019 and October 2020. Outcome events were defined using hospitalisations, GP records and cause of death data. Results For all outcomes except deaths there was a lower count of events in April 2020 compared to a year earlier. 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). Deaths saw an increase of 73.4% between April 2019 and April 2020. Despite the hospitalised COVID-19 population making up just 0.14% of the population in April 2019, they accounted for a high proportion of events in that month (range of proportions 10.3% (DVT) to 33.5% (AKI)). When only counting the events in people with a record of COVID, the decrease was much greater, ranging from 23.0% (stroke) to 50.5% (heart failure). Interpretation We observed a large drop in recording of all cardiometabolic and pulmonary complications in the non-COVID general population, alongside frequent occurrence of these outcomes in patients hospitalised with COVID.