COVID-19 repercussions on cardiac services will be with us for years to come

A new study reveals the damage caused to cardiovascular programs by the COVID-19 pandemic will continue to accrue unless mitigation strategies are implemented quickly. People have avoided hospitals and doctors during the first two years of the pandemic, resulting in a number of people dying at home from heart conditions. 

The University of Leeds study published in the European Heart Journal found “substantial global collateral damage” caused by the disruption to cardiac services from the SARS-CoV-2.[1] The study also found there was significant disparity in severity based on country income classification.

In the two years from December 2019, when health systems around the world were under extreme pressure and people were fearful of catching COVID-19, individuals experiencing acute cardiac events such as heart attacks and heart failure either stayed away from hospitals or could not get admitted to a hospital.  

Reflected in earlier studies and physician observations around the world, the study describes a “substantial global decline” in hospital admissions of people suffering from cardiovascular disease, according to a statement. In cases where people did get medical help, there was, on average, more than an hour’s delay in reaching hospital or having contact with paramedics. The chances of people surviving a major heart attack depends on timely and appropriate treatment. 

“This analysis really brings to light the substantial impact the COVID-19 pandemic has had and will continue to have in harming cardiovascular health globally," explained Deepak Bhatt, MD, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital, professor of medicine at Harvard Medical School and a senior author in the paper, said in the statement.

Although the problems identified by the researchers were seen across the world, they were exacerbated in low- to middle- income countries, study authors found. 

Hospitals and clinics in those locations struggled to give the gold-standard treatment, in some cases using thrombolytics instead of interventional procedures to insert a stent into a blocked artery. The authors content this has led to an increased death rate among cardiovascular patients in hospitals in low- to middle-income countries, as well as more people dying at home from cardiovascular disease in the U.K.  

In many low to middle income countries there was a sharp decline in interventional revascularization. Numbers for percutaneous coronary intervention (PCI) were reduced to just 73% of patients having a major heart attack, and 69% of cases where the patient was suffering a less severe heart attack. 

There also were treatment delays, according to the study. On average, it was taking patients 69 minutes longer to receive medical assistance for a serious heart attack after the start of their symptoms.  

Involving an international team of doctors and data scientists led by the University of Leeds, the study gives the first global assessment of the way cardiovascular services coped during the pandemic. The research team analyzed data from 189 separate research papers looking at COVID-19's impact on cardiovascular services from 48 countries on six continents and covering a two-year period from December 2019 to December 2021.  

“Heart disease is the number one killer in most countries – and the analysis shows that during the pandemic people across the world, people did not receive the cardiac care they should have received, and that will have ramifications," explained Ramesh Nadarajah, MA, MB BChir, MRCPa, a British Heart Foundation Clinical Research Fellow at the University of Leeds and lead author of the paper, said in the statement. “The longer people wait for treatment for a heart attack, the greater the damage to their heart muscle, causing complications that can be fatal or cause chronic ill health. Health systems need to reinforce systems to help support and treat people whose heart conditions will inevitably be worse because of the pandemic. The paper provides evidence of that.” 

Previous systemic reviews of the impact of COVID-19 on cardiovascular services have presented an “incomplete overview," the researchers said. To address that, they comprehensively investigated a range of heart services, from hospitalizations, heart disease management, diagnostic procedures, outpatient consultations and mortality rates and across regions. They combined data from multiple studies to give a value for the number of cases hospitals and clinics were seeing compared to the expected caseload if there was not a pandemic. 

Data from low to middle income countries is sparse and the researchers believe their fundings underplay the true extent of the impact of COVID-19 disruption on heart services in low- to middle-income countries. WThe authors warned the disruption to cardiovascular services will leave a legacy requiring prompt action on the part of health administrators. 

WHO calculated 14.9 million excess deaths globally due to COVID

“This research shows how the COVID-19 pandemic has disrupted cardiac services at all levels and across all continents, and it would be important to continue studying the impact of this disruption," explained Samira Asma, assistant director-general for data, analytics and delivery for impact at the World Health Organization (WHO), and one of the paper’s authors.

“The analysis is revealing that the burden of COVID-19 has disproportionately fallen on low- to middle-income countries, and we suspect it will widen the inequality gap in health outcomes of cardiac care between high-income countries and low- to middle-income countries, where 80% of the world's population live," she said. "This underscores the need for universal health coverage and access to quality care, even more so during the pandemic.” 

Earlier in May, WHO published estimates of the excess deaths associated with COVID-19 pandemic, including people who were unable to access prevention and treatment for cardiovascular diseases due to overwhelmed health systems. During 2020 and 2021, WHO calculated there were 14.9 million excess deaths globally. This included higher than reported numbers in the U.S.