Cardiac services around the world suffered substantial disruption due to the COVID-19 pandemic, a major new study out today shows.
The research, which was led by the University of Leeds and is the first global assessment of the way cardiovascular services coped during the pandemic, warns that unless “mitigation strategies are speedily implemented”, the problem will continue.
The study, published in the latest European Heart Journal, says there has been a “substantial global decline” in hospital admissions of people with cardiovascular disease in the two years from the start of the pandemic.
This has led to an increased number of people dying at home or in the community from heart conditions and when people did get medical help there was, on average, more than an hour’s delay in reaching hospital or having contact with paramedics.
The study authors say while these problems were experienced globally, they were particularly acute in low- to middle-income countries where hospitals and clinics struggled to give the gold standard treatment.
The team analysed data from 189 research papers that examined COVID-19’s impact on cardiovascular services from 48 countries on six continents over two years from December 2019.
Lead author Dr Ramesh Nadarajah, a British Heart Foundation clinical research fellow at the University of Leeds, said: “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.
“That will have ramifications. 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. Health systems need to be reinforced so they can support and treat people whose heart conditions will inevitably be worse because of the pandemic. The paper provides evidence of that.”
To address the “incomplete review” of previous systemic reviews of the impact of COVID-19 on cardiovascular services, the researchers investigated a range of heart services across regions, from hospitalisations, heart disease management, diagnostic procedures, outpatient consultations and mortality rates.
They combined data from multiple studies to give a value for the number of cases hospitals and clinics were seeing compared to the expected caseload if there was not a pandemic.
Data from low to middle-income countries is sparse and the researchers believe their findings underplay the true extent of the impact of COVID-19 disruption on heart services in those areas.
The found globally that hospitals experienced a 22% drop in people experiencing a STEMI heart attack and a 34% decline in people attending hospital with an NSTEMI heart attack.
On average, it took patients 69 minutes longer to receive medical assistance for a serious heart attack after the start of their symptoms.
In many low to middle-income countries there was a sharp drop in gold-standard treatment – insertion of a stent into the blocked artery: 73% of cases where the patient was having a major heart attack and 69% of cases where the patient was suffering a less severe heart attack. Instead, patients were treated with clot busting drugs.
Globally, there was a 34% drop in heart operations and 51% of the electronic implantable devices compared to the non-COVID-19 period.
Among patients in hospital after having had a major heart attack or heart failure, the number of people dying from any cause was up by 17%, driven by an increase in the death rates among cardiovascular patients in low- to middle-income countries.
Senior author Professor Chris Gale, consultant cardiologist, said: “The repercussions of the COVID-19 pandemic on cardiovascular care and outcomes will be with us for a long while yet.
“There is little doubt that there will continue to be deaths and illness that would not have otherwise occurred. Urgent action is needed to address the burden of cardiovascular disease left in the wake of the pandemic.”
Study author Dr Samira Asma, assistant director-general for data, analytics and delivery for impact at the World Health Organization (WHO), added: “The analysis is revealing that the burden of COVID-19 has disproportionately fallen on low to middle income countries and 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.”
Calling for an urgent plan to help cardiac services, the British Heart Foundation (BHF) says the findings provide evidence of further pressure on already overwhelmed cardiac services in England.
Figures from the BHF show that at the end of March 2022, 309,796 people were waiting for cardiac treatment in England – a figure that has been growing over the previous 21 months.
Consultant cardiologist Dr Sonya Babu-Narayan, associate medical director at the BHF, said: “We need a comprehensive and specific cardiovascular plan to address the burden of cardiovascular care including the backlog – and provide immediate and long-term solutions to our cardiovascular workforce shortage.
“Without this we will continue to see heart attacks, lasting heart damage, or even premature deaths that could have been avoided.”
The collateral damage of COVID-19 on cardiovascular services – a meta-analysis. European Heart Journal 31 May 2022.
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