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There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both \u2018direct\u2019, through infection, and \u2018indirect\u2019, through changes in healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n\u2009=\u20092), Italy (n\u2009=\u20091), and China (n\u2009=\u20095) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3\u00a0862\u00a0012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).<\/jats:p>\n                    <jats:p>Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60\u2013100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2\u20133\u2009months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31\u00a0205 and 62\u00a0410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49\u00a0932 to 99\u00a0865 deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaa155","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T23:13:55Z","timestamp":1609456435000},"page":"1599-1609","source":"Crossref","is-referenced-by-count":132,"title":["Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-3411","authenticated-orcid":false,"given":"Amitava","family":"Banerjee","sequence":"first","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA"},{"name":"Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE"},{"name":"Department of Cardiology, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, UK, E1 1BB"},{"name":"University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suliang","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA"},{"name":"Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 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