Leeds cardiologist’s recommendations to COVID inquiry

A national Cardiovascular Data Centre should be set up to improve care for people with heart disease after excess patient deaths were recorded during the COVID-19 pandemic, says a Leeds cardiologist.

Professor Chris Gale has produced a report for the COVID inquiry, which was published following the hearings on 31 October. It found that acute cardiovascular deaths in the community increased beyond expectations for the time of year - which was also likely due to people staying away from hospital.

His report found that data sharing and reporting happened in record time, which was a key strength of the NHS's response to the pandemic - and establishing a UK-wide data centre would bring together different systems from the four devolved administrations, enabling better sharing and a more robust response.

His report makes four key recommendations:

• The care of people with ischaemic heart disease should be prioritised during and after periods of external stressors.
• The establishment of a UK National Cardiovascular Data Centre for monitoring ischaemic heart disease (and wider cardiovascular diseases).
• There should be enhanced preparedness of clinical services for people with and at risk of ischaemic heart disease.
• During periods of external stressors there should be effective decisions and communication with the public and healthcare professionals alike.

Professor Gale was instructed by the UK Public Inquiry into COVID-19 to serve as the Independent Expert for Cardiovascular Disease and prepare a report into the impact of the pandemic on the UK's care delivery for ischaemic heart disease.

He said: "There was an unnecessarily tragic toll on the lives of people with and at risk of cardiovascular disease. The prevention of cardiovascular disease was largely abandoned, and people feared coming to hospitals so much that there was a substantial decline in admissions with heart attack.

"The pandemic witnessed an excess of deaths from cardiovascular disease. Messaging depicted through the media of the adverse situation occurring in other countries and to stay at home to protect the NHS coupled with an insufficient response about the need to attend hospital in the event of a medical emergency such as heart attack were critical causative factors.

"Cardiovascular services were reconfigured to protect lifesaving pathways - but patients with a heart attack were less likely to come to hospital."

Ischaemic heart disease is the most common cause of premature death in the UK, with more than 100,000 hospital admissions for heart attacks and nearly 70,000 deaths each year. It occurs when the heart's blood supply is reduced or blocked.

Published with contributions by Dr Ramesh Nadarajah from the University of Leeds' School of Medicine, the report features key recommendations for the care of patients with and at risk of the disease. It emphasises the importance of placing people first, enhancing national data flows, preparedness planning, and effective communication so that cardiovascular services in the UK are resilient to future crises.

Chris Gale is Professor of Cardiovascular Medicine in the University's School of Medicine and Honorary Consultant Cardiologist at the Leeds Teaching Hospitals NHS Trust. Dr Nadarajah is NIHR Academic Clinical Lecturer in Cardiology and Health Data Research UK Fellow.

Professor Gale said: "Data assets in the UK were able to offer insights into how the COVID-19 pandemic impacted care for people at risk of cardiovascular disease, but were skewed towards acute presentations, and analysis was not coordinated or conducted by governmental organisations but was reliant on academic institutions and charities.

"A larger and sufficiently protected specialist workforce, and greater preparedness, would have enabled the continuation of more NHS services for people with ischaemic heart disease. Should there have been a substantial increase in admissions with cardiovascular disease, it is plausible that the services would have been overwhelmed and adverse consequences occur.

"Establishing a UK National Cardiovascular Data Centre, utilising digital technologies, increasing capacity, and establishing standardised routes for data flows and dissemination can improve the robustness of ischaemic heart disease services in the NHS to future external stressors.

"The dissemination of appropriate, timely and consistent information about ischaemic heart disease must be made available to the public - via a range of sources - so that they are sufficiently informed of when and how to access treatment for clinical emergencies and routine care. The NHS website and app should be promoted as a trusted source of healthcare information and a first point of call for patient education.

"Effective workforce planning and investment in the cardiovascular workforce is fundamental to maintaining the cardiovascular health of the nation. There must be an expansion in the number and training of cardiologists as well as specialist nurses, radiographers and cardiac physiologists."

Professor Gale's report also highlights successes achieved by the NHS workforce which he suggests should form part of any future health crises.

The report states that NHS staff who treated patients with cardiovascular disease during the pandemic went above and beyond their normal duties, and often made great sacrifices to ensure high quality care of patients.

He underlines the feeling of purpose, professionalism and comradery, and the adaptability of the cardiovascular community to deliver the best care and outcomes for patients; the British Heart Foundation and the British Cardiovascular Society's publicity campaigns encouraging people with heart attack symptoms to attend hospital; the feasibility of remote working to conduct virtual consultations and triage patients; and the high quality care for patients with heart attack.

And he describes the ability to rapidly link and publicly report national NHS data in near real time as a key success of the response to the pandemic, which should continue. He also found that academic organisations were a key source of capacity and capability for cardiovascular data analyses and reporting.

The independent UK COVID-19 Inquiry has been set up to examine the UK's response to and the impact of the pandemic, and learn lessons for the future. It is chaired by Baroness Heather Hallett, a former appeal court judge, who has the power to compel the production of documents and call witnesses to give evidence on oath.

It was opened in October 2022. There is no specific timescale for how long it will last, but Baroness Hallett aims to hold the final public hearings in 2026.

Contact University of Leeds press officer Lauren Ballinger with media enquiries via email on [email protected] or by phone on 0113 3438059.

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