All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study

On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established card...

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Published in:European heart journal Vol. 42; no. 15; p. 1516
Main Authors: Butt, Jawad H, Fosbøl, Emil L, Gerds, Thomas A, Andersson, Charlotte, Kragholm, Kristian, Biering-Sørensen, Tor, Andersen, Julie, Phelps, Mathew, Andersen, Mikkel Porsborg, Gislason, Gunnar, Torp-Pedersen, Christian, Køber, Lars, Schou, Morten
Format: Journal Article
Language:English
Published: England 14.04.2021
Subjects:
Brain Ischemia
Cardiovascular Diseases
Cohort Studies
Communicable Disease Control
COVID-19
Denmark - epidemiology
Humans
Registries
SARS-CoV-2
Stroke
Denmark
COVID-19
Cardiovascular disease
Mortality
ISSN:1522-9645, 1522-9645
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Abstract On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87-0.95; IRR 0.95, 95% CI 0.89-1.02; and IRR 0.87, 95% CI 0.83-0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97-1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88-0.96; out-of-hospital, IRR 1.04, 95% CI1.01-1.08). These trends were consistent irrespective of sex and age. Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.
AbstractList On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures.BACKGROUNDOn 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures.Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87-0.95; IRR 0.95, 95% CI 0.89-1.02; and IRR 0.87, 95% CI 0.83-0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97-1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88-0.96; out-of-hospital, IRR 1.04, 95% CI1.01-1.08). These trends were consistent irrespective of sex and age.METHODS AND RESULTSUsing Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87-0.95; IRR 0.95, 95% CI 0.89-1.02; and IRR 0.87, 95% CI 0.83-0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97-1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88-0.96; out-of-hospital, IRR 1.04, 95% CI1.01-1.08). These trends were consistent irrespective of sex and age.Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.CONCLUSIONSAmong patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.
On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87-0.95; IRR 0.95, 95% CI 0.89-1.02; and IRR 0.87, 95% CI 0.83-0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97-1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88-0.96; out-of-hospital, IRR 1.04, 95% CI1.01-1.08). These trends were consistent irrespective of sex and age. Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.
Author Andersen, Mikkel Porsborg
Andersen, Julie
Biering-Sørensen, Tor
Fosbøl, Emil L
Torp-Pedersen, Christian
Andersson, Charlotte
Gislason, Gunnar
Butt, Jawad H
Kragholm, Kristian
Gerds, Thomas A
Phelps, Mathew
Schou, Morten
Køber, Lars
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  surname: Butt
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  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  surname: Gerds
  fullname: Gerds, Thomas A
  organization: Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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  surname: Andersson
  fullname: Andersson, Charlotte
  organization: Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University, MA, USA
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  surname: Kragholm
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  organization: Departments of Cardiology, North Denmark Regional Hospital and Aalborg University Hospital, Denmark
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  surname: Biering-Sørensen
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  surname: Andersen
  fullname: Andersen, Julie
  organization: The Danish Heart Foundation, Copenhagen, Denmark
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  organization: The Danish Heart Foundation, Copenhagen, Denmark
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  givenname: Mikkel Porsborg
  surname: Andersen
  fullname: Andersen, Mikkel Porsborg
  organization: Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
– sequence: 10
  givenname: Gunnar
  surname: Gislason
  fullname: Gislason, Gunnar
  organization: Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
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  givenname: Christian
  surname: Torp-Pedersen
  fullname: Torp-Pedersen, Christian
  organization: Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
– sequence: 12
  givenname: Lars
  surname: Køber
  fullname: Køber, Lars
  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
– sequence: 13
  givenname: Morten
  surname: Schou
  fullname: Schou, Morten
  organization: Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark
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Issue 15
Keywords COVID-19
Cardiovascular disease
Mortality
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SubjectTerms Brain Ischemia
Cardiovascular Diseases
Cohort Studies
Communicable Disease Control
COVID-19
Denmark - epidemiology
Humans
Registries
SARS-CoV-2
Stroke
Title All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study
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