Patients “fearful” of seeking cardiac care during pandemic

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Analysis of data from English hospitals suggests that there was a sharp decline in the number of people admitted to hospitals with acute heart failure or a heart attack ahead of the country’s second COVID-19 lockdown in November 2020.

The trend, detailed in a letter to the Journal of the American College of Cardiology (JACC) mirrors a similar pattern seen during the first period of lockdown in England earlier in the year. Researchers from the University of Leeds (Leeds, UK), who examined the trend, suggest that the data points to fear among some members of the public of attending hospital despite having medical emergencies.

Time series graph showing daily hospital admissions from sample hospitals in England for patients with heart attack and acute heart failure

The decline—41% fewer people attending with heart failure and 34% with a heart attack compared to pre-pandemic levels—is approaching the size of that observed during the first wave of the pandemic, the researchers suggest.

Chris Gale, professor of Cardiovascular Medicine at the University of Leeds, who supervised the data analysis, said: “I am afraid that we are seeing a re-run of one of the preventable tragedies of the first wave – people were either too afraid to go to hospital for fear of contracting COVID-19 or were not referred for treatment.

“The message to patients needs to be clear. If they experience symptoms of a heart attack or acute heart failure, they need to attend hospital. These are unforgiving medical emergencies. With the right help, people can recover from them. But if patients delay or avoid treatment, their will suffer life-limiting complications—or they will die.”

Jianhua Wu, Associate Professor at the University of Leeds, led the analysis. Commenting on the data, he said: “One of the worrying aspects of our research is that the decline we have seen since October may not have yet bottomed out. Inevitably there is a fear that will result in deaths that perhaps could have been avoided.”

SCAI survey

Concerns also exist among the reluctance of patients in the USA to seek medical attention. In the past week, survey results published by the Society for Cardiovascular Angiography & Interventions (SCAI) has suggested that as many as 40% of Americans do not feel safe going to the doctor due to the COVID-19 risk. SCAI says that this data comes at an important time in the pandemic when there has been a more than 20% decrease in primary care visits since the onset of the COVID-19 pandemic, and a nearly 40% drop in patients being treated for ST-segment–elevation myocardial infarction (STEMI).

“COVID-19 has changed the healthcare landscape as we know it, with consequences that will reverberate potentially for years to come. One challenge we can help prevent today is the impact of chronic disease among individuals who have fallen out of care due to fear of the virus,” said Cindy Grines, SCAI president, and chief scientific officer, Northside Cardiovascular Institute, Atlanta, USA. “Cardiac care can’t wait for a time without COVID-19. We’ve seen an increase in medical emergencies like heart attacks and stroke, and the impact of cardiac patients delaying treatment for progressive heart conditions like aortic stenosis and atrial fibrillation, which can result in more complications and time spent in the hospital. For the millions of patients with heart disease, don’t let fear stand in the way of better outcomes and quality of life.”

Increasing cardiovascular-related deaths

Further data emerging from the USA suggests that the number of cardiovascular deaths—not directly attributable to COVID-19—has increased during the pandemic. In a new study, published in JACC, researchers from the Richard A and Susan F Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC), Boston, USA, analysed data from the National Center for Health Statistics to compare the rate of cardiovascular-related deaths before and after the onset of the pandemic in the USA, relative to the same periods in the prior year.

Rishi K Wadhera

“Hospital visits for heart attacks and other cardiac conditions declined markedly during the pandemic, fuelling physicians’ concerns that people with acute conditions may be staying at home due to fear of exposure to COVID-19,” said the study’s corresponding author, Rishi K Wadhera, a cardiologist and researcher at the Smith Center and BIDMC. “Our research raises concern that the avoidance of hospitals, deferral of semi-elective procedures and care, and substantial strain imposed on hospitals during the early phase of the pandemic may have had an indirect toll on patients with cardiovascular disease.”

Wadhera and colleagues evaluated the rate of US deaths due to cardiovascular causes after the onset of the COVID-19 pandemic (mid-March to June 2020) relative to the immediately preceding 11 weeks pre-pandemic. The team also compared these two periods of 2020 to the same weeks in 2019. The team found a significant rise in cardiac deaths after the onset of the pandemic in the USA. Deaths due to ischaemic heart diseases (related to narrowing of the arteries) and hypertensive (related to high blood pressure) diseases increased by 11% and 17%, respectively, compared to the previous year.

“These data are particularly relevant today, as we find ourselves in the midst of a surge in COVID-19 cases that looks to be exceeding what we experienced last spring,” said senior author Robert Yeh, director of the Smith Center for Outcomes Research at BIDMC. “Ensuring that patients with cardiovascular disease continue to receive necessary care during our public health response to the pandemic will be of paramount importance.”


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