AIMS The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. METHODS AND RESULTS A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20-2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43-3.10) vs. 1.21 (95% CI 1.07-1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). CONCLUSIONS In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.

中文翻译：

---

COVID-19 大流行对心血管疾病院内死亡率的影响：荟萃分析。


目标 COVID-19 大流行直接导致了因 COVID-19 和其他疾病（包括心血管 (CV) 疾病）造成的死亡率过高。我们的目的是探讨一系列心血管疾病中与 COVID-19 感染无关的院内死亡率过高。方法和结果 对未感染 SARS-CoV-2 的 CV 疾病患者的院内死亡率与 COVID-19 大流行之外的时期进行比较的研究进行了系统检索。分析中纳入了 15 项针对 27 421 名 CV 疾病患者的研究。 COVID-19 组的平均院内死亡率为 10.4% (n = 974)，对照组为 5.7% (n = 1026)。与 COVID-19 大流行以外的时期相比，合并风险比 (RR) 显示，在 COVID-19 期间，院内死亡率增加了 62% [95% 置信区间 (CI) 1.20-2.20，P = 0.002]。在 COVID-19 大流行期间入院率下降 >50% 的研究观察到，与入院率下降 <50% 的研究相比，死亡率增加幅度最大 [RR 2.74 (95% CI 2.43-3.10) vs. 1.21 (95% CI 1.07- 1.37), P< 0.001]。观察到的死亡率增加在不同 CV 条件下是一致的（交互作用 P = 0.74）。结论 与大流行之外的时期相比，因心血管疾病入院的患者的院内死亡率有所增加，与同时感染 COVID-19 无关。在入院率下降幅度最大的研究中，这种效应更大，表明这一时期的患者病情更严重。然而，研究普遍进行得不好，需要进一步精心设计的研究来确定与 COVID-19 感染不直接相关的死亡率的全部范围。