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COVID-19 and Hospital Admission for Heart Attack / Stroke

Leads: Prof Richard Lilford, Dr Katharine Reeves (Meths), Dr Gavin Perkins (Acute Care Interfaces)

Dates: March - April 2020

Background:

Attendance at Accident and Emergency departments in the UK is widely reported to have decreased precipitously since national lockdown was introduced on March 23, 2020. Daily ambulance callouts for heart attacks and strokes are routinely recorded by ambulance crews for the West Midlands Ambulance Service University NHS Foundation Trust, the second largest such service in the UK.

Policy and Practice Partners:

West Midlands Ambulance Service NHS Foundation Trust.

Co-Funding Partners:

West Midlands Ambulance Service NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust.

Aims and Objectives:

To compare data over the same periods pre- and post-lockdown in order to see any change in the overall mean number of admissions of patients with heart attack or stroke.

Methods:

We analysed data collected from week 1 of 2016 to week 17 of 2019 and compared to the same period in 2020 pre and post lockdown. We tested for the presence of a structural break in the time series of annually differenced weekly admissions (using a linear model with AR errors.

Main Results:

There was little evidence for such a break in either the STEMI (year-on-year change in mean callouts associated with lockdown: –9∙1, 95% CI: –21∙8 to 3∙6; p=0∙17) or stroke (–21∙7, –47∙6 to 4∙2; p=0∙11).

Conclusions:

These data do not confirm a reduction in ambulance callouts for our two tracer health conditions. Although we cannot exclude such an effect, any effect must be of small magnitude. The COVID-19 pandemic might be associated with negative collateral health effects, but we find no evidence that people are reluctant to call an ambulance when they experience symptoms of stroke or heart attack.

Implications for Implementation:

The public can be reassured that frequent claims of major reductions in reporting for these critical conditions were unfounded.

Publication:

Reeves K, Watson SI, Pankhurst T, Khunti K, Gallier S, Skrybant M, Chilton PJ, Lilford RJ. No Evidence for Reduced Hospital Admissions or Increased Deaths from Stroke or Heart Attack During COVID-19. medRxiv 2020.06.08.20119636; doi: https://doi.org/10.1101/2020.06.08.20119636.