Extreme heart care disruption has caused 30,000 excess deaths involving heart disease in England since the start of the pandemic.
This figure cannot be solely attributed to disruption in care. Almost 21,000 people suffering with heart disease died with Covid-19 listed as the underlying cause in this period. This may have been another significant contributing factor.
On 2 November the British Heart Foundation (BHF) claimed in a comment from its chief executive that “ongoing and extreme disruption to heart care has meant that 30,000 more families have lost a loved one”.
The charity added in an online article announcing its new report on the topic: “Since the pandemic began, there have been just over 30,000 excess deaths involving heart disease - on average over 230 additional deaths a week above expected heart disease death rates.”
The BHF’s figures, which related to excess deaths in England, were extremely widely reported in the media. With the help of Full Fact’s artificial fact checking tools, we found them referenced in articles from the BBC, the Times, the BMJ, the Guardian, MailOnline, the Sun, the Mirror, the Evening Standard, twice in the Express, Wales Online and in the print edition of the Telegraph.
But the claim that the excess deaths are down to care disruption, and some of the coverage of the BHF’s figures, is missing some important context, because around 21,000 people whose deaths involved heart disease during this period died with Covid-19 as the underlying cause.
In other words, healthcare disruption may have been a factor in the higher-than-expected number of heart disease deaths during this period, but Covid-19 itself also appears to be a significant part of the explanation. This was not mentioned in the BHF’s original online article announcing its analysis, and the BHF told us its press release used similar language, though both the article and the press release did include a link to its report, which does mention Covid-19 as a possible factor.
The first line of the charity’s original online article and press release did state that “severe ambulance delays, inaccessible care and ever-growing waiting lists are contributing to heart patients dying needlessly”, though they did not identify any other specific factors which may have contributed.
When Full Fact contacted the BHF, the charity changed part of its online statement to say that “Covid-19 infection was likely a significant factor in excess coronary heart disease-related deaths during the first year of the pandemic”—context which did not originally appear in many of the articles covering it.
The BHF also corrected the comment attributed to its chief executive. At the time of publication, the BHF told us that it had not yet sent these updates to the media who reported it.
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The BHF included more detail on its figures in an accompanying report, where it says that in England from the onset of Covid-19 through to August 2022, “around 124,000 more people in total have died than we would have expected to see under ‘normal’ conditions over this length of time”.
The report then states: “From March 2020 through to August 2022, there have been just over 30,000 excess deaths involving ischaemic heart disease (IHD)—the most common type of heart disease—in England.”
These numbers are derived from the official government data on excess mortality in England, which begins 27 March 2020—the day after the first UK-wide Covid-19 lockdown was legally implemented.
The government data shows that between 27 March 2020 and 31 August 2022, there were 243,000 registered deaths with IHD mentioned as a cause of death on the death certificate at the time of writing. (Death certificates can mention multiple causes, one of which is classified as the underlying cause.)
This is 29,956 more than expected over the same time period—a measure called ‘excess deaths’.
People with IHD mentioned on their death certificate may have died directly from it, or it may have been a factor in a death that had a different underlying cause.
In this period, the statistics also show that in England 20,886 people with IHD mentioned on their death certificate had Covid-19 listed as the underlying cause of death.
To be clear, it is possible that these people would have died during this period even if they had not caught Covid. It is also possible that disruption to healthcare played some role in many of their deaths.
However, when trying to explain why around 30,000 more people than expected died with IHD, it seems important to include the fact that around 21,000 IHD sufferers caught a previously unknown virus and died with it listed as the underlying cause. It also seems very uncertain that the entire excess was caused by disruption to healthcare, as some of the coverage and the original quote from the BHF chief executive suggested.
A spokesperson for the British Heart Foundation said that their report recognised that “Covid-19 infection was likely a significant factor in excess [IHD]-related mortality during the first year of the pandemic”, but also that “Covid infection is no longer a driving force behind the excess [cardiovascular disease] death rate”.
The charity accepted that “this nuance [that Covid-19 infection was likely a significant factor in excess IHD-related mortality during the first year of the pandemic] is not clearly communicated in the article on our website summarising the contents [of] our Tipping Point report, and [we] are happy to rectify this”.
The spokesperson added: “Undoubtedly, many of the 29,956 excess deaths in this period [27 March 2020 and 31 August 2022] involving IHD were specifically caused by Covid-19 infection.
“However, we cannot assume that every death with Covid-19 as an underlying cause represents an ‘excess death’ within the [Office for Health Improvement and Disparities] data, as we cannot point to individual deaths and say whether they are 'excess' or not (i.e. whether they would have happened anyway, due to other causes, without the pandemic) because this is defined at an aggregate level.
“What we can say is that the number of deaths with Covid-19 as an underlying cause cannot account for the aggregate excess we see with IHD involved.”
The chief executive of the BHF, Dr Charmaine Griffiths, was quoted in the original release as saying: “It is devastating that the ongoing and extreme disruption to heart care has meant that 30,000 more families have lost a loved one.”
After Full Fact got in touch with the BHF this was updated to: “It is devastating that the ongoing and extreme disruption to heart care has contributed to 30,000 more families losing a loved one.” This change is noted in an update note at the bottom of the article.
A spokesperson for the charity said: “We also accept that a quote from our Chief Executive should say that disruption to heart care has ‘contributed to’ 30,000 more families losing a loved one, and we are happy to rectify this.”
Professor James Doidge, a senior statistician for the Intensive Care National Audit and Research Centre and honorary associate professor at the London School of Hygiene & Tropical Medicine, told Full Fact: “At an individual level, attribution of cause of death is inherently imperfect and subjective. Covid-19 may trigger a death in someone with IHD that it may not in someone without IHD, or it may trigger a death in someone with IHD that it may not if services for IHD were less disrupted.
“Death is nearly always the result of multiple contributing factors and quantitatively estimating the relative contribution of each factor is something that is only even theoretically possible at a population level.”
It’s important to note that Covid-19 deaths in people with IHD can’t be totally separated from IHD deaths—people who died with an underlying cause of Covid-19 in the period covered by the report may not have died if they hadn’t already had IHD.
Professor Kevin McConway, emeritus professor of applied statistics at The Open University, told Full Fact: “Consider someone who dies with IHD and Covid and the doctor thinks that really both lay behind the death, i.e that if they had only had IHD or only had Covid they wouldn’t have died. The issue was that they had both.”
A spokesperson for the charity also said: “The data for the second year of the pandemic clearly illustrate our claim that significant disruptions to care are driving excess deaths involving IHD”.
A spokesperson said: “In this period, of the total 135,370 registered deaths involving IHD in England, 4,659 (3.4%) were listed as having Covid-19 as the underlying cause. Notably, however, there were 12,825 excess deaths in this period involving IHD. Hence, even if every single case of death involving IHD where Covid-19 was the underlying cause represented an ‘excess death’ (which is highly unlikely to be the case), then these would still only account for a minority (36%) of excess deaths involving IHD from the second year of the pandemic onwards.”
The BHF’s report also says that Covid itself may be a factor in subsequent IHD deaths, saying: “There is growing evidence that people with previous Covid infection have a higher risk of developing subsequent cardiovascular disease.”
Image courtesy of Ian Taylor
Update 24 November 2022
This fact check has been updated to include a quote from the British Heart Foundation’s article which described disruption to care as “contributing” to patient deaths. We have also updated the conclusion box to make it clearer that Covid-19 may have been another significant contributing factor to excess deaths.
As detailed in our fact check, the BHF changed part of its online statement and corrected the comment attributed to its chief executive.
The BHF subsequently told us it has contacted a number of the media publications which covered the story to highlight the changes made to the original press release and quote.
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