The number of people presenting with serious heart problems at a Scottish hospital more than halved during the first month of lockdown.

The number of people diagnosed with heart attacks at Dumfries Royal Infirmary also fell by 40%, according to the research published today in the journal Open Heart.

In what is believed to be the first study in the UK to assess the impact of Covid-19 on cardiac services and clinical activity, the researchers found that there were just 18 admissions for chest pain at the DRI between March 21 and April 20.

This compared to 40 between January 21 and February 20, and 35 over the four weeks prior to lockdown.

Heart attack admissions also fell from 30 in each of the four week periods prior to lockdown, to 18 in the first month after restrictions were imposed.

Overall, the number of patients referred by GPs to cardiology outpatient clinics fell by 80% (from 386 to 76).

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As a result, face-to-face clinics dropped by 93% (from 474 to 30) alongside a substantial increase in the use of the virtual clinics.

The researchers say a combination of factors were at play, including the restructuring of NHS services to cope with the pandemic, reduced access to primary care, and patients’ reluctance to seek medical help due to fear of catching the virus in hospital.

Deaths from heart attacks and heart failure have been among the main causes of non-Covid excess deaths since March.

They write: “At the height of the pandemic, it is acceptable to deviate from the standard level of care and agreed guidelines in order to prioritise the delivery of essential services.

“However, adverse consequences for some patients presenting with worsening of their underlying cardiac conditions have been inevitable.”

They add that increased use of virtual clinics deployed during the emergency will be a positive “long-lasting legacy" from the pandemic, but stress that cardiology services nationally should prepare for "a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.”

It came as a new report by Public Health Scotland found that the death rate during the peak of the pandemic was 32 per cent higher than average.

Between March 16 to June 21, there were an extra 96 deaths per 100,000 compared to 2015-2019 levels.

Covid-19 accounted for 82% of these excess deaths, but there was also a rise in fatalities linked to other causes such as dementia, diabetes, strokes and heart disease.

PHS also reported a "striking" increase in excess deaths from external causes such as traffic collisions and violence, despite lockdown measures.

Its report said: "Our findings provide some support for the hypotheses that excess mortality from causes other than Covid-19 in Scotland may have resulted from reduced use of health services by those that need them, and from unintended consequences of measures taken to control the spread of the virus.

"For example, reduced use of hospitals or primary care services might explain the excess mortality from cancer, circulatory causes and diabetes.

"Also, physical distancing measures have been anecdotally linked to deterioration of physical and mental health of dementia and Alzheimer's patients."

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It added: "The reduced traffic volumes and the closure of establishments serving alcohol for consumption on the premises during the period might have been expected to lead to a decrease in deaths from traffic accidents and violence, which makes the increase in deaths from external and ill-defined causes even more striking."

It added most of the excess non-Covid-19 deaths in England and Wales were also due to dementia, Alzheimer's disease and "ill-defined causes".

Deaths for those in the most deprived areas increased by 136 to 550 per 100,000, while those in the least deprived increased by 71 to 286 per 100,000.

The report added: "People living in the most deprived areas of Scotland have experienced the biggest absolute increases in deaths from dementia/Alzheimer's, external and ill-defined causes, circulatory causes and diabetes mellitus during the Covid-19 excess deaths period."