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Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic. We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs. Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37–43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38–46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12–29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29–45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2–9) in 2019 to 3 days (1–5) by the end of March, 2020. Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses. UK Medical Research Council, British Heart Foundation, Public Health England, Health Data Research UK, and the National Institute for Health Research Oxford Biomedical Research Centre.

ObjectiveTo describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.MethodsRetrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death.ResultsAfter 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.Conclusions and relevanceThe COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.

Background In 2017 NHS England started rolling out a model where women have continuity of carer with the same midwifery team throughout the perinatal period. This study uses national data to test whether women of different groups receiving midwife continuity of carer had lower stillbirth rates and higher rates of a first feed of breast milk than women receiving standard care. Methods We compared the two outcomes for women placed on the midwife continuity of carer pathway by 24 weeks and women receiving standard care in England, with logistic regression standardising between groups. We used the Maternity Services Dataset covering 922,149 women conceiving between 2020 and 2022. Results Combining all demographic groups, women on a midwife continuity of carer pathway have a higher first feed of breast milk rate ( p  < 0.001), but do not show a difference in stillbirth rate, compared to women receiving standard care. However, Black women on this pathway have lower stillbirth rates ( p  = 0.047) compared to Black women receiving standard care, the only demographic group showing a difference. Women with no antenatal appointment at all by 24 weeks have much higher stillbirth rates than those with an appointment ( p  < 0.001). Conclusions The findings that midwifery continuity of carer increases the first feed of breast milk uptake, which has health benefits. It may decrease stillbirth rates for Black women. Both findings inform future policy development and research. Further investigation and outreach around women not coming forward for timely antenatal care may also be beneficial. Roebuck et al. analysed 922,149 records to investigate the impact of midwife continuity of carer throughout the perinatal period in England on stillbirth and first newborn feed. They find an increase in first feed of breast milk, reduced stillbirth in Black women, and increased stillbirth in women not receiving any antenatal care by 24 weeks. Plain language summary In 2017, NHS England introduced continuity of midwife care, where women are supported by the same midwife team throughout pregnancy, birth, and after the baby’s birth. We explored its impact using national data from women who became pregnant between 2020 and 2022. We compared women receiving this new approach of continuity of midwife care with those receiving standard care. More women under this new approach provided a first feed of breastmilk. Overall stillbirth rates were similar between the two groups. However, Black women under this new approach had lower stillbirth rates compared to Black women in standard care. We also found women with no antenatal appointments by 24 weeks of pregnancy were more likely to experience a stillbirth. These findings can help shape policies and research and encourage earlier access to antenatal services.

To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non–COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group. Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.

[...]96% of these episodes related to babies less than 1 week old, with the most likely explanation being that all these episodes were birth related and therefore treated by associated specialties. For help or further information, or if readers spot any other findings in our data that they think are of interest, please contact enquiries@ic.nhs.uk or telephone +44 (0)845 300 6016.

A question on what leaders require from HR is answered. Many leaders know very little about what great HR can do for them and the alignment between what they can offer and what they need is often not clearly explained by the HR. All leaders should have to do is identify the risks that concern them and their plans to improve the performance of their organization and then it is down to HR to offer simple solutions that help them deliver. These concerns include: 1. Make sure transactional HR is working well. 2. Move on to transformational priorities. 3. Help organizations be the best.

It is actually simple to improve organisational performance significantly in a relatively short time at little or no cost. Within an organisation, it needs to be driven from the very top as a strategic initiative, facilitated by Human Resource and made to happen in every team, by every leader. At a team level, line managers can do it themselves. In six months, a positive change could be seen. In years, it will transform performance. But if you want a real competitive advantage, or to be world class or the best in your field, just maximising effort isn't enough. Senior leaders need to make sure that two or three critical objectives for the organisation are communicated to everyone so that everybody's efforts can be focused on delivery.