Heart disease: Patients dealt 'double blow' in pandemic, expert says
Some of the excess mortality numbers during the peak of the COVID-19 epidemic were driven by patients with heart conditions, says a cardiologist.
Cardiovascular disease patients in the UK are being dealt a double blow by the COVID-19 pandemic, a leading cardiologist has said.
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation, told MPs that those with heart disease and other cardiovascular conditions are not only at increased risk of coronavirus-related death, they are also “dying in excess of expected numbers from their heart and circulatory disease unrelated directly to COVID-19”.
Speaking at the Lords Science and Technology Committee, she said: “We are seeing the tragic effect of COVID-19 and statistics related to deaths.
“Whilst COVID-19 explains 80 per cent of the excess mortality you’ve seen during the peak of the pandemic, it does not explain all. And it does seem that some of this excess mortality is driven by patients with heart and circulation conditions.”
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She said during the peak of the pandemic, there were more than 700 excess deaths from heart and circulatory diseases in just one week, including around 300 from coronary heart disease and nearly 200 from the stroke.
Dr Babu-Narayan added: “Across the whole of the pandemic there have been 3,600 excess deaths from heart and circulatory diseases. This raises concern that perceived or real barriers and access to care potentially caused avoidable harm. And this should not be repeated.”
She said there was a 66 per cent reduction in heart failure admissions and a 50 per cent drop in emergency department attendances for myocardial ischemia, which occurs when blood flow to the heart muscle is obstructed by a partial or complete blockage of a coronary artery and can lead to a heart attack.
According to Dr Babu-Narayan, waiting lists at the end of July show that there are more than 180,000 people waiting for investigations and treatment in cardiology or cardiothoracic surgery.
She said: “We need to restore and maintain vital heart services.”
Dr Babu-Narayan said clinicians should move towards more individualised risk assessments for patients who may have heart disease.
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She added: “Moving forward, patients need clarity about which things they should not delay so that the health service can protect them, rather than them protecting the health service.
“They need to know about which symptoms are changing symptoms or red flags that mean they should seek medical advice but also call up if their care has been postponed.”
She also said more needs to be done for ethnic minority groups in the UK.
Dr Babu-Narayan said: “It’s very concerning to see that people whose ethnic background is non-white have had different care pathways, have had delayed care.”
She added: “I think we need solutions for that.”
Other experts at the hearing said while COVID-19 is a respiratory disease affecting the lungs, it can also cause damage to other organs such as the kidneys and the central nervous system and also have psychological consequences.
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Professor Chris Brightling, senior investigator at the National Institute for Health Research, said: “I am very mindful that this is a multi-organ impact which also then goes beyond typical medical responses but also includes the impact on mental health – which we need to then acknowledge and then manage for those who have been affected by COVID-19.”
An NHS spokesperson said: “While some people had understandable concerns about coming forward for care, emergency support for heart conditions at England’s A&Es quickly rebounded to normal levels during the first peak, and importantly hospital admissions are now around 95 per cent of usual levels, with the number of calls to 999 and 111 now above the same time last year.
“The NHS has continued to deliver care, including for urgent and routine heart problems and stroke, throughout the pandemic, and while it’s important people respect the advice to stay safe, the NHS remains open, so people shouldn’t hesitate to come forward for care and advice when they need it.”
Reader Q&A: Should you give the kiss of life to someone having a heart attack?Asked by: Dan Jones, London
When faced with someone who’s collapsed and not breathing, the best medical advice is to first call 999 and then perform CPR – cardiopulmonary resuscitation. This involves locking your fingers together and pushing down hard and fast on the casualty’s chest until paramedics arrive. But there’s controversy about combining this with mouth-to-mouth resuscitation – the ‘kiss of life’, also known as ‘rescue breaths’.
Multiple studies suggest that the added benefits aren’t worth the pause in the chest compressions, and the prospect of using it on complete strangers is thought to deter many people from doing anything at all. Nevertheless, the British Heart Foundation and the NHS both still recommend using mouth-to-mouth where possible, suggesting an alternative ‘hands-only’ CPR for those who don’t feel comfortable giving rescue breaths or who haven’t been trained.