Peter Libby, MD, a cardiovascular medicine specialist with Brigham and Women’s Hospital and professor of medicine with Harvard Medical School, explained how atrial fibrillation (AFib) can develop in long-COVID patients. He also discussed some of the vast health inequities seen during the pandemic.
Many COVID-19 patients, even some with mild cases, have developed new-onset AFib during or shortly after the acute phase of the virus. Arrhythmias are also a somewhat common issue among long-COVID patients.
According to Libby, research shows COVID-19 causes microvascular damage and disfunction, which may lay the substrate on the atrial myocardium for the atrial fibrillation. He said more research is needed in this area.
"I think it is perfectly reasonable that there would be a push toward atrial myopathy in some people who had severe cardiovascular involvement with SARS-CoV-2," Libby explained.
Early on in the pandemic there were major concerns that COVID-19 may cause an epidemic of heart failure because damage to the heart was seen in a large number of patients. Up to three-quarters of severely ill patients had evidence of myocardial injury on MRI, but it was found most patients did recover over time.
"That has not panned out to be such a frequent problem, but I would be concerned about setting the stage for long-term consequences, including arrhythmia," he said. However, more data is needed to better tie together the cause and effect of COVID-19 and new onset arrhythmias.
COVID-19 magnified health disparities
Libby also said it is important to stress the glaring health disparities that became very more evident during the pandemic.
"As practitioners, one thing we need to keep in mind is that the pandemic really put inequities and disparities in our healthcare system and in cardiovascular care in stark relief," Libby explained.
He noted Brigham and Women's Hospital serves the urban core of Boston, including a housing project near the hospital, as well as patients from the suburbs that tend to have a much higher level of income.
"People from the housing project do not have broadband internet, could not do remote visits with video, who had much less access to healthcare," Libby said. "We really need to take this as a wakeup call to address the disparities in our healthcare system, and each of us is responsible for addressing that in our daily work."
Watch a related discussion with Libby where he provides more details in the VIDEO: Why does COVID-19 damage vascular beds?
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com