Meta-analysis reveals “global collateral damage” of pandemic on cardiovascular care

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A study has revealed the “global collateral damage” caused by the disruption to cardiac services caused by the COVID-19 pandemic. Writing in the European Heart Journal, researchers warn that problems with heart health will “…continue to accrue unless mitigation strategies are speedily implemented”.

The study describes a “substantial global decline” in hospital admissions of people suffering from cardiovascular disease. As a result, the number of people dying at home or in the community from heart conditions increased, the researchers suggest.

Although the problems identified by the researchers were seen across the world, they were exacerbated in low to middle income countries. The result has been an increased death rate among cardiovascular patients in hospitals in low to middle income countries, as well as more people dying at home from cardiovascular disease in the UK.

Involving an international team of doctors and data scientists led by the University of Leeds, the study gives the first global assessment of the way cardiovascular services coped during the pandemic. In the meta-analysis, the research team analysed data from 189 separate research papers looking at COVID-19’s impact on cardiovascular services from 48 countries on six continents and covering a two-year period from December 2019.

Ramesh Nadarajah, a British Heart Foundation Clinical Research Fellow at the University of Leeds (Leeds, UK) and lead author of the paper, said: “Heart disease is the number one killer in most countries—and the analysis shows that during the pandemic people across the world, people 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 reinforce systems to help support and treat people whose heart conditions will inevitably be worse because of the pandemic. The paper provides evidence of that.”

Previous systemic reviews of the impact of COVID-19 on cardiovascular services have presented an “incomplete overview”, say the researchers. To address that, they comprehensively investigated a range of heart services from hospitalisations, heart disease management, diagnostic procedures, outpatient consultations and mortality rates and across regions. 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 wasn’t 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 low to middle income countries.

Samira Asma, assistant director-general for data, analytics and delivery for impact at the World Health Organization (WHO) and one of the paper’s authors, said: “This research shows how the COVID-19 pandemic has disrupted cardiac services at all levels and across all continents, and it would be important to continue studying the impact of this disruption.

“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.”

Deepak L Bhatt (Brigham and Women’s Hospital, Boston, USA) and a senior author in the paper, said: “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.”

Analysis presented at EuroPCR 2022 (17–20 May, Paris, France) has shown that patients in England with ST-elevation myocardial infarction (STEMI) had an average loss of 1.86 years of survival during the first month of lockdown, compared with before the lockdown, with a corresponding loss of quality of life.


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