Coronavirus infection increases the chance of death due to cardiovascular diseases (CVDs) (COVID-19). There are also concerns that the pandemic has impacted acute cardiovascular care supply and demand. We calculated both 'direct' (via infection) and 'indirect' (through changes in healthcare) excess mortality in particular CVDs. Data on mortality suggests that indirect effects on CVD will be delayed rather than immediate (peak RR 1.14). In eight hospitals throughout China, Italy, and England, CVD service activity dropped by 60–100% compared to pre-pandemic levels. Even after reducing the lockdown, activity in China remained below pre-COVID-19 levels for 2–3 months, and activity in Italy and England is still low. The supply and demand for CVD services has decreased considerably across countries, posing the risk of significant, but avoidable, excess mortality during and after the pandemic.
