Q&A: Cardiologist discusses COVID-19 and its impact on patient care

COVID-19, especially the omicron variant, is still surging through the United States, putting a tremendous strain on the nation’s healthcare systems.

Some patients with COVID-19, we've learned, can encounter heart problems. SARS-CoV-2, the virus that causes COVID-19, may directly infect heart cells, impact blood vessels or contribute to abnormal blood clotting, according to the National Heart, Lung, and Blood Institute. 

Also, the CDC points out, patients with underlying cardiac conditions such as heart failure and coronary artery disease are at a higher risk for developing severe disease.

In addition, a recent study published in the Journal of the American Heart Association showed that hospitalized COVID-19 patients with myocardial injury have an increased risk of developing adverse outcomes. Even mild and moderate cases of COVID-19 can impact a patient’s heart and cardiovascular system, according to another recent analysis. 

What's the latest news on this ongoing pandemic? How are cardiologists coping with rising COVID-19 cases and over-crowded, understaffed hospitals?

Eric Stecker, MD, MPH, an electrophysiologist at Oregon Health & Science University and chair of the American College of Cardiologist’s Science and Quality Committee, addressed those questions, and others, in an exclusive interview with Cardiovascular Business.

Based on everything you've seen, which COVID-19 patients face the highest risk for cardiac problems?

Eric Stecker: The answer to this question is actually involved with related questions. The first is, what is the risk of death from acute COVID-19 among patients with cardiovascular disease? This is significantly driven by older age, severity of underlying heart disease, male gender and a variety of other coexisting health factors. And, unfortunately, the socioeconomic determinants of health such as poverty, racial/ethnic minority, etc. that strongly influence overall mortality appear to also influence COVID-related mortality.

The second related question is, who is at a high risk of experiencing cardiovascular adverse events or cardiovascular death with acute COVID-19? One of the most important issues to recognize is that a large risk for cardiac problems occurs when people delay or defer care. Over the course of the pandemic, many people have had fatal heart attacks, cardiac arrest or other major cardiac events because they ignored symptoms or did not see their doctor for routine visits for prevention, evaluation and treatment.

There are, of course, also significant cardiovascular risks among people with active COVID-19. These are generally related to the severity of the underlying cardiovascular disease prior to COVID as well as the severity of COVID illness, and other pre-existing health problems.

How has COVID-19 impacted burnout among cardiologists?

I can say that the overall American healthcare workforce has been very negatively impacted by the pandemic. Not just physicians, but nurses, nurse practitioners, physician assistants and many others who work to care for patients are experiencing burnout.

Most cardiologists are less directly impacted by having to care for large numbers of patients with COVID-19 daily. However, they can be indirectly impacted by the inability to offer their usual level of high-quality care for procedures when hospitals are overburdened with patients admitted for COVID. And even the routine functioning of cardiology clinics and inpatient consultative services are severely impacted when key personnel quit or are not able to come to work due to COVID-19.

Almost two years into the pandemic, how is cardiac care being impacted? 

Fortunately, our ability to sustain traditional high-quality cardiovascular care and the average patient's understanding of the importance of seeking both routine and acute cardiovascular care are both much better than at the very beginning of the pandemic. Nonetheless, we must be vigilant and use the lessons learned from the earlier days to prevent backsliding. This is a substantial risk with the current omicron wave coming during the winter, when hospital capacity in many parts of the country is already routinely limited.