A sudden surge of chest pain can be traumatic enough, but when it happens during a public health care crisis, the implications are more worrisome.
Paul King, an Ontario heart patient, saw delays in his diagnosis for heart disease and three reschedules of bypass surgery after experiencing chest pain in November 2020. He lived with uncertainty until May 2021, when he finally underwent a seven-hour heart procedure.
According to a 2021 survey from the Heart and Stroke Foundation on the impact of the pandemic, King's case isn't surprising. The survey of 3,000 individuals or their caregivers living with stroke, heart disease or cognitive impairment, showed two in three reporting at least one medical appointment delayed or cancelled during the pandemic.
A further survey of Canadian health professionals and researchers highlighted that COVID-19's impact on heart and brain health continues to be substantial, with implications for treatment, prevention and research.
“Patients with heart failure are seeing delays in care, not going for blood work, not getting testing done,” said Dr. Gavin Oudit, cardiologist and researcher at the Mazankowski Alberta Heart Institute in Edmonton. He points to one case of a patient whose legs were badly swollen upon presenting to the clinic last spring. Oudit says he knew the fluid build-up signalled advanced heart failure, which tests confirmed. The man had delayed seeking help, Oudit says, because of fear of going to a hospital during the pandemic.
Oudit’s concerns are shared by most of the 370 heart and stroke professionals who responded to the survey. Virtually all reported the pandemic impacted their work, and three-quarters said the impact has been major. Oudit also points to worrisome data out of the U.S., which shows an increased risk of diabetes in COVID-positive adolescents.
“There is a misnomer that COVID is a bad cold--it's much more," Oudit said. "It has system-wide impact."
One direct consequence is the virus’ impact on the cardiovascular system and the brain. COVID-19 can cause direct injury to blood vessels and lead to heart failure, pulmonary embolism--a type of blood clot--and stroke.
“We realize the respiratory system is likely to have some degree of system wide illness: also in the gut, the liver and the kidney,” stressed Oudit, who holds the Canada Research Chair in heart failure.
Seventy-two per cent of survey respondents believe the pandemic has highlighted the importance of health promotion/prevention and a need to focus on rehabilitation and community support for recovery.
“It’s now even more critical. Prevention has been put on the back burner by many people, and we are seeing weight gains, drops in exercise," said Oudit of pandemic-caused changes in physical activity. "Rehab is being overwhelmed.”
However, Oudit says the pandemic has had positive consequences too, including a greater reliance on virtual link-ups. Over 80 per cent of those surveyed said they had virtual health care appointments during COVID-19, with the majority saying the interactions were beneficial and convenient.
“People are comfortable getting virtual support with, for instance, home-based exercise programs. This can really work,” said Oudit, urging those with a heart condition to stay connected to care providers, see a specialist as needed, and follow up with diagnostic results.
“So many patients have reached out to family too, (which provides) the psycho-social connections no health provider can provide," he said. "Family support is a big part of this story.”
A Canada-wide Heart & Stroke Foundation/Environics Research survey (summer 2021) of 370 health professionals showed:
· 90% were concerned the health of people living with heart disease, stroke or vascular cognitive impairment worsened due to inability to access proper care during the pandemic.
· 82% saw delays in diagnosis and treatment
· 54% cite mental health issues as significant for people living with heart disease or stroke as a result of the pandemic.
· 54% worried about a decrease in cardiovascular health in people who did not have existing conditions prior to the pandemic.
· 78% worry the pandemic has slowed or stopped critical heart and brain health research.
· 80% believe the healthcare gap--between those who receive adequate care and those who don’t--has widened
Respondents said the biggest post-pandemic challenges facing the system include health care provider burnout and increased wait times for appointments and procedures.
Online surveys of people living with a heart condition, stroke or vascular cognitive impairment and caregivers (Over 4,000 people total in May 2020 and spring 2021) showed half of respondents reporting concerns about going to hospital if they need help. As well:
· Two thirds of people living with a heart condition, stroke or vascular cognitive impairment had at least one medical appointment changed, delayed or cancelled during the pandemic.
· Six in 10 respondents rated virtual appointments as good as in-person interactions, and eight in 10 confirm virtual appointments were convenient.
· The biggest challenges reported by people living with a heart condition, stroke or vascular cognitive impairment are feeling isolated, a lack of informal support, unhealthy lifestyle behaviours and access to health services.
· Positives include having friends and family available, participating in exercise and recreation activities safely and an ability to cope.