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. 2022 Apr:212:44-50.
doi: 10.1016/j.thromres.2022.02.008. Epub 2022 Feb 20.

Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area

Davide Voci  1 , Ugo Fedeli  2 , Ioannis T Farmakis  3 , Lukas Hobohm  4 , Karsten Keller  4 , Luca Valerio  3 , Elena Schievano  2 , Claudio Barbiellini Amidei  5 , Stavros V Konstantinides  6 , Nils Kucher  1 , Stefano Barco  7
Affiliations

Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area

Davide Voci et al. Thromb Res. 2022 Apr.

Abstract

Background: Pulmonary embolism is a known complication of coronavirus disease 2019 (COVID-19). Epidemiological population data focusing on pulmonary embolism-related mortality is limited.

Methods: Veneto is a region in Northern Italy counting 4,879,133 inhabitants in 2020. All ICD-10 codes from death certificates (1st January 2018 to 31st December 2020) were examined. Comparisons were made between 2020 (COVID-19 outbreak) and the average of the two-year period 2018-2019. All-cause, COVID-19-related and the following cardiovascular deaths have been studied: pulmonary embolism, hypertensive disease, ischemic heart disease, atrial fibrillation/flutter, and cerebrovascular diseases.

Results: In 2020, a total of 56,412 deaths were recorded, corresponding to a 16% (n = 7806) increase compared to the period 2018-2019. The relative percentage increase during the so-called first and second waves was 19% and 44%, respectively. Of 7806 excess deaths, COVID-19 codes were reported in 90% of death certificates. The percentage increase in pulmonary embolism-related deaths was 27% (95%CI 19-35%), 1018 deaths during the year 2020, compared to 804 mean annual deaths in the period 2018-2019. This was more evident among men, who experience an absolute increase of 147 deaths (+45%), than in women (+67 deaths; +14%). The increase was primarily driven by deaths recorded during the second wave (+91% in October-December). An excess of deaths, particularly among men and during the second wave, was also observed for other cardiovascular diseases, notably hypertensive disease, atrial fibrillation, cerebrovascular disease, and ischemic heart disease.

Conclusions: We observed a considerable increase of all-cause mortality during the year 2020. This was mainly driven by COVID-19 and its complications. The relative increase in the number of pulmonary embolism-related deaths was more prominent during the second wave, suggesting a possible underdiagnosis during the first wave.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Total deaths by month in Veneto, Italy (year 2020 vs. mean of the years 2018–2019). Exponential increase of the number of deaths during the two epidemic waves of coronavirus disease in the year 2020 (blue line) compared to the mean number of deaths in the years 2018–2019. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Monthly excess deaths. Overall and by mention of COVID-19 as underlying or concomitant cause in Veneto, Italy (year 2020 vs mean of years 2018–2019). Exponential increase during the two epidemic waves of COVID-19 in the total monthly excess deaths in the year 2020 vs mean of the years 2018–2019 (blue line) and monthly excess deaths caused by (red dotted line) and with mention of (red continuous line) COVID-19. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Deaths from pulmonary embolism. Overall and by concomitant mention of COVID-19 in Veneto, Italy (year 2020 vs mean of years 2018–2019). Exponential increase of the number of deaths for pulmonary embolism during the year 2020 (red dotted line) vs the mean numbers of deaths for pulmonary embolism in the years 2018–2019 (continuous red line). Number of deaths for pulmonary embolism without mention of COVID-19 during the year 2020 (blue line). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
Trends in monthly cause-specific mortality in Veneto, Italy (year 2020 vs mean of years 2018–2019).
Fig. 5
Fig. 5
Excess mortality by cause: absolute deviation in 2020 compared to the mean in 2018–2019 in Veneto, Italy. Panel A. Age group <50 years; Panel B. Age group 50–64 years; Panel C. Age group 65–79 years; Panel D. Age group >80 year.
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References

    1. Vandoros S. Excess mortality during the COVID-19 pandemic: early evidence from England and Wales. Soc. Sci. Med. 2020;258 - PMC - PubMed
    1. Solomon M.D., McNulty E.J., Rana J.S., Leong T.K., Lee C., Sung S.H., et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N. Engl. J. Med. 2020;383(7):691–693. - PubMed
    1. Kansagra A.P., Goyal M.S., Hamilton S., Albers G.W. Collateral effect of COVID-19 on stroke evaluation in the United States. N. Engl. J. Med. 2020;383(4):400–401. - PMC - PubMed
    1. Wu J., Mamas M., Rashid M., Weston C., Hains J., Luescher T., et al. Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic. Eur. Heart J. Qual. Care Clin. Outcomes. 2021;7(3):238–246. - PMC - PubMed
    1. Banerjee A., Pasea L., Harris S., Gonzalez-Izquierdo A., Torralbo A., Shallcross L., et al. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet. 2020;395(10238):1715–1725. - PMC - PubMed