January 12, 2021, MedPage today reported on the first studies describing the indirect effects of COVID-19 on cardiovascular testing and deaths worldwide. As part of a review of the highlights of the year, we report on the ongoing challenges in closing the backlog for routine cardiac care.
While COVID-19 vaccines were cleared late last year, 2021 was the year vaccination finally became available to most Americans, many of whom had had disrupted cardiovascular care the previous year. – whether for fear of contracting SARS-CoV-2 in health establishments. , because their elective procedures were canceled, or for other reasons.
With widespread COVID vaccination in place by the spring of 2021, it was hoped that more patients would return to medical care they had denied for months.
For example, the sharp reduction in adult heart surgery volumes in the United States from April 2020, along with high procedural mortality, was documented in a study of the Adult Heart Surgery Database of the United States. Society of Thoracic Surgeons. In July 2020, cardiac surgery volumes are said to have rebounded to approximately pre-pandemic levels – although they are still not sufficient to make up for the build-up of missed surgeries accumulated in the first year of the pandemic.
However, in May 2021, things appeared to be back to normal. Hospitals were no longer packed and more than half of America’s adult population was at least partially vaccinated against COVID-19. Interventional cardiologists said their cath labs had resumed operations as usual for months. In Israel, where more adults were vaccinated, operators were working longer hours to make up for the backlog in catheterizations.
Yet the recent wave of Omicron infections around the world has raised concerns that cardiovascular care systems are about to be tested again.
“Our services for heart disease patients at the Royal Edinburgh Infirmary are currently unchanged. The main challenge for the cardiology services will be to maintain staff levels over the winter period. We are already overloaded and with no more community transmission of coronavirus, our colleagues will have to be flexible and cover staff absences to maintain these services, ”said cardiologist Nicholas Mills, MBChB, PhD, from his institution in Scotland.
The importance of staffing was highlighted when an interventional cardiologist was registered as Israel’s first Omicron COVID-19 patient in late November. He reported extreme fatigue for 72 hours and was back to the catheterization lab, still weak, 10 days after his diagnosis.
“The most important message for our patients is that they must continue to seek help for acute cardiac care despite the pandemic and the emergence of Omicron,” said Mills. MedPage today in mid-December.
“Right now we take care of patients the way we do, but of course we are concerned that patients and staff are contracting COVID in this wave. Contingency planning is key and just makes sure everyone is trying to stay as safe as possible. and being fully boosted by vaccinations is key, ”said interventional cardiologist Ajay Kirtane, MD, SM, of Columbia University Irving Medical Center / NewYork-Presbyterian in New York City.
In the United States, more than 72% of adults are fully vaccinated – gaps in vaccination resulting in part from fears of side effects.
Fanning the flames were alarming reports of myocarditis following COVID vaccination throughout the year, which were countered by studies suggesting a favorable clinical course for those affected, even in a diverse population. There was general consensus that post-vaccine myocarditis is rare, although some estimates are higher than others.
For clinicians, the greatest concern was the long-term suffering of heart patients given their weight gain, lifestyle changes and delayed health care during the pandemic. Even the American Heart Association announced that it was recoiling its impact objective for 2020-2023 to increase life expectancy in the world; its new orientation towards 2024 would rather focus on health equity projects.
US faces wave of CCD deaths and disabilities [common chronic diseases], especially cardiometabolic diseases … The fight against COVID-19 has given us a glimpse of what is possible. If we act now, we can dramatically reduce the damage from the impending tsunami, ”wrote former FDA commissioner (and current nominee for a return term) Robert Califf, MD, of Verily Life Sciences, in a commentary published in April.
In one recent policy statement adapted to the pandemic, the European Society of Cardiology reminded people with cardiovascular disease to continue to maintain a healthy lifestyle, take their prescribed heart medications and follow their heart monitoring appointments .