COVID-19’s impacts on heart disease will be with us for years to come

The COVID-19 pandemic has caused major disruptions to heart health services, a new meta-analysis published in the European Heart Journal reveals. COVID-19 impacts on cardiac health have likely been driven by a combination of healthcare system pressures and the spread of the virus itself.   

“Heart disease is the number-one killer in most countries, and the analysis shows that during the pandemic people across the world did not receive the cardiac care they should have received,” says lead author Ramesh Nadajarah, a British Heart Foundation Clinical Research Fellow at the University of Leeds, UK. “That will have ramifications.”

The analysis reports a notable global decline since the start of the pandemic in people being admitted to hospital with cardiovascular disease, longer delays in accessing treatment, and increased death rates from cardiovascular disease.

For example, there was a 22% decline in hospitalisations for serious heart attacks in which one artery connected to the heart is completely blocked. A less-severe form of heart attack, in which an artery is partially blocked, saw an even greater drop in hospitalisations of 34%. 

Heart-attack patients had to wait on average 69 minutes longer than before the pandemic to receive medical assistance. The paper also reported a 34% drop in heart operations globally, and a 17% increase in people dying in hospital after experiencing a major heart attack.

“This analysis really brings to light the substantial impact the COVID-19 pandemic has had, and will continue to have, in harming cardiovascular health globally,” says Deepak L. Bhatt, senior author on the meta-analysis and a professor of medicine at Harvard Medical School as well as executive director of interventional cardiovascular programs at Brigham and Women’s Hospital, US.

COVID-19 impacts on cardiac health will persist and reinforce inequalities if not addressed, experts say

The findings were based on an analysis of data from 189 research papers from 48 countries across six continents, all investigating the impact of COVID-19 on cardiovascular health services in the two years from December 2019.

Although the impacts of the pandemic on cardiovascular healthcare were observed globally, many were concentrated in low- and middle-income countries. These countries saw greater declines in hospital attendance for heart attacks and a “sharp” decline in the percentage of heart-attack patients receiving the gold standard of medical care.

“The analysis is revealing that the burden of COVID-19 has disproportionately fallen on low- to middle-income countries,” says Samira Asma, a co-author on the paper and Assistant Director-General for Data, Analytics and Delivery for Impact at the World Health Organization (WHO).  

“We suspect it will widen the inequality gap in health outcomes of cardiac care between high-income countries and low- to middle-income countries, where 80% of the world’s population live. This underscores the need for universal health coverage and access to quality care, even more so during the pandemic.”

The disruption caused by the pandemic is likely to cause ongoing health impacts well into the future. Delayed and missed opportunities for diagnosis and treatment cause compounding cardiovascular health problems.  

“The longer people wait for treatment for a heart attack, the greater the damage to their heart muscle, causing complications that can be fatal or cause chronic ill health,” Nadajarah says.

“Health systems need to reinforce systems to help support and treat people whose heart conditions will inevitably be worse because of the pandemic.”

The research team called for mitigation strategies to deal with the increased burden of death and disease from cardiovascular disease to be rapidly implemented around the world.

“The repercussions of the COVID-19 pandemic on cardiovascular care and outcomes will be with us for a long while yet,” says senior author Chris Gale, a consultant cardiologist and professor at the University of Leeds.

“Urgent action is needed to address the burden of cardiovascular disease left in the wake of the pandemic.”