As health-care professionals, we are focused on preparing for and implementing effective management strategies for the onslaught of COVID-19 patients. This pandemic represents an unprecedented operational challenge for our health-care systems and leadership. As cardiovascular specialists, we are also concerned for an unexpected but significant potential effect of this pandemic — a future second wave of cardiovascular complications.
What is happening worldwide is that health-care providers are seeing fewer and fewer patients with acute cardiac conditions coming to hospitals. This concerning drop in health-care utilization corresponds to the onset of the COVID-19 pandemic and widespread social distancing. For example, every day in hospitals, are typically encounter at least two or three new patients presenting with acute coronary syndromes (“heart attacks”). Also, several patients with new or worsening heart failure who require hospitalization and urgent care. Primary care doctors in rural or smaller hospitals routinely contact hospitals in urban cities to refer cardiac patients for management.
It is eerily quiet in the cardiac units while they wait for the invisible enemy to strike. Some may say that fewer heart attacks are a good thing.
Many hospitals can use cardiac units for an increased number of COVID-19 patients. They can have cardiac health-care workers available for the management of critically ill pandemic patients, and less stress on the usual diagnostic testing and procedural services that would otherwise be busy with cardiac patients. So why are we worried?
Unfortunately, heart disease does not disappear or significantly decrease in prevalence during a pandemic, which leads us to ask...
Where are all the cardiac patients? What is happening to them?
There are many theories about this. People with known heart disease or such risk factors as high blood pressure and diabetes could be social distancing and staying at home, avoiding stress, and being more compliant with their medications. One could speculate that people are using the threat of lung complications with COVID-19 as an impetus to quit smoking. These changes in behavior, if true, would be welcomed, but would not realistically explain the immediate and dramatic reduction in patients presenting to hospitals with heart attacks, heart failure, and other urgent cardiac issues.
Our concern is that many vulnerable cardiac patients are still out there, either not seeking the help they need or not referred for cardiac assessment because of our overwhelming focus on the COVID-19 pandemic. The predominant messaging from the media is to stay home if you are sick and call your community/public health call number if you have flu-like symptoms like a fever or cough. Health-care professionals have postponed or canceled standard testing, including screening tests for the identification of major cardiovascular issues. They have suspended all but the most urgent and emergent cardiac interventions, including surgery for coronary artery and valvular heart disease. They delay clinic visits, opting for phone or video calls for those we feel are most urgent.
You can also read: What is Heart Failure: FamilyAssets
These measures are reasonable and prudent in a crisis. However, we must ask if we have inadvertently given our communities the impression that medical issues other than COVID-19 are less critical?
Many patients may be fearful of being infected if they come to the hospital. We hear this from hospitals who´s ambulatory clinic patients claim that. Could health-care professionals be attributing cardiac symptoms such as chest pain as symptoms of COVID-19? Are we under-investigating for cardiovascular diseases and its complications? There are many questions. We won’t have the answers we seek until this pandemic is over.
These patients are still out there. Their cardiac conditions will not go away. While we must continue to address the pandemic as a priority, we must remember that heart disease is still the leading killer worldwide even during a pandemic. We will lose far more people in our communities to cardiovascular disease this year and every year, than from COVID-19 complications.
Patients need to know that they are important and that during the pandemic and post-pandemic, they can still receive medical care, even at home. We will do everything we can to provide them with the care they need when they need it. Cardio-HART by Cardio Phoenix Inc. is a Cardiac-Telemedicine™, AI-Powered heart screening and diagnostic device for front-line use in all patient clinical care situations, in particular Primary Care Telemedicine. Is the perfect social distancing medical device that will allow cardiac patients to be treated and seen by their primary care Dr. or Cardiologist. We can do this effectively during the pandemic.
Our patients should not dismiss chest pain, worsening shortness of breath, or other cardiac symptoms out of fear or misunderstanding of our health-care priorities. We are here for you if you need us. Come and see us.