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Further evidence that COVID-19 pandemic has led to indirect cardiovascular deaths

Writing in the Journal of the American College of Cardiology,  Dr Rishi K Wadhera (Beth Israel Deaconess Medical Center, Boston, USA) and colleagues found that ischaemic heart disease and hypertensive diseases increased after the onset of the pandemic in 2020 compared with changes over the same period in 2019. This finding adds to the growing body of evidence that the COVID-19 pandemic has indirectly — through people not seeking medical attention or disruptions in the delivery of standard healthcare services — led to an increase in cardiovascular deaths.

Using data from the US National Center for Health Statistics, Wadhera et al  looked at death rates from cardiovascular causes in the USA from 18 March 2020 to 2 June 2020 (the pandemic) and from 1 January 2020 to 17 March 2020 (before the pandemic). They then compared these rates with those from the same periods in 2019. The authors found that deaths from ischaemic heart disease (e.g. heart attacks) and hypertensive (high blood pressure) diseases increased after the onset of the pandemic in 2020 compared with changes over the same period in 2019. However, deaths related to heart failure, cerebrovascular disease or other diseases of the circulatory system did not change in the USA.

According to Wadhera et al, New York City experienced the largest relative increase in deaths due to ischaemic heart disease (139%) and hypertensive diseases (164%) during the pandemic. The remainder of New York state, New Jersey, Michigan and Illinois also experienced significant increases in deaths due to these conditions, while Massachusetts and Louisiana did not see a change in cardiovascular deaths.

Dr Wadhera comments: “Our findings suggest that the pandemic may have had an indirect toll on patients with cardiovascular disease, potentially due to the avoidance of hospitals out of fear of exposure to the virus, increased healthcare system strain and the deferral of semi-elective procedures and care. US public health officials and policymakers should improve public health messaging to encourage patients with acute conditions to seek medical care.”

In another study, also published in the Journal of the American College of Cardiology, Andrew J Einstein (Columbia University Vagelos College of Physicians and Surgeons, New York, USA) and colleagues sought to determine the full magnitude of reductions in diagnostic heart disease procedures in 2020, because of the pandemic, and how that might impact long-term cardiovascular disease outcomes.

Based on surveys of 909 inpatient and outpatient centres performing cardiac diagnostic procedures in 108 countries, Einstein et al found that procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Specifically, transthoracic echocardiography decreased by 59%, transoesophageal echocardiography by 76% and stress tests by 78%. Coronary angiography (invasive or computed tomography) decreased 55%. The authors also classified countries into four economic levels (low, lower-middle, upper-middle and high) and found that location in a low/lower-middle income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.

Dr Einstein comments: “These findings raise serious concerns for long-term adverse cardiovascular health outcomes resulting from decreased diagnosis. Efforts to improve timely patient access to cardiovascular diagnosis in this and future pandemics, particularly in low- and middle-income countries, are warranted.”

While the pandemic has put health services in many countries, such as the UK, under strain, they remain open for people with, non-COVID, life-threatening conditions. Arrhythmia Alliance, and its sister charity AF Association, urges anyone who detects an irregular pulse to seek medical attention. An irregular pulse may be a symptom of atrial fibrillation (AF). Without appropriate therapies and treatment, AF can cause devastating — and potentially fatal — strokes. Therefore, an irregular pulse should not be ignored. Find out more about our Know Your Pulse campaign.

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