England needs an urgent recovery plan for cardiac services, according to the British Heart Foundation (BHF) after new research outlined the global "collateral damage" of the COVID-19 pandemic on heart health.
The international study showed dramatic drops in hospital cases for heart attacks around the world, especially in middle and low income countries, meaning the number of people dying at home or in the community from heart conditions increased.
Decline in Heart Operations and Emergency Service Delays
The BHF said the study is evidence of the pressure on cardiac services in England, with more than 300,000 people now waiting for treatment.
During the pandemic, hospitals around the world saw a 22% decline in people attending hospital following a serious heart attack, where one of the arteries serving the heart is completely blocked, and a 34% decline in people attending with a less severe heart attack, where an artery is partially blocked, according to the study led by the University of Leeds.
It found there was there was a 34% drop in heart operations across the world.
In cases where people did get medical help there was, on average, more than an hour's delay in reaching hospital or having contact with paramedics, the researchers found.
Consultant cardiologist 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."
Waiting List Numbers Rising
The BHF said that 309,796 people were on a waiting list for cardiac treatment in England at the end of March.
The charity said this figure has been growing for the previous 21 months.
In the review, the team analysed data from 189 separate research papers looking at COVID's impact on cardiovascular services from 48 countries, covering a 2-year period from December 2019.
The study described a "substantial global decline" in hospital admissions, hospitals, and clinics struggling to give the gold standard treatment, with some examples of drugs being used instead of interventional procedures such as fitting a stent into a blocked artery.
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.
The researchers said: "Collateral cardiovascular damage from missed diagnoses and delayed treatments will continue to accrue unless mitigation strategies are speedily implemented. The deferral of interventional procedures, especially for structural heart disease, leaves many patients at high risk of adverse outcomes."
Professor Chris Gale, consultant cardiologist and senior author, 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."
The study found that, globally, the number of people dying from any cause among patients in hospital after having had a major heart attack or heart failure was up by 17%.
This was driven by an increase in the death rates among cardiovascular patients in low to middle income countries.
Studies from the early phase of the pandemic in the UK revealed a "displacement of death" effect where more people were dying from acute coronary events at home – running at 31% rather than the expected 24%. In care homes, the figures were 16% versus 14%.
'The collateral damage of COVID-19 on cardiovascular services – a meta-analysis' is published in the European Heart Journal.
NHS Initiative for Measuring Blood Pressure
The NHS is aiming to restore diagnosis, monitoring and management of hypertension, atrial fibrillation, and high cholesterol to pre-pandemic levels in 2022/23.
It said it is supporting patients to diagnose and manage their risk of Cardiovascular Disease (CVD) in a number of ways including rolling out blood pressure checks in pharmacies for the over-40s, and with more than 220,000 blood pressure monitors which have been allocated across England to enable patients to measure their blood pressure through the NHS Blood Pressure @Home initiative.
The NHS has set requirements for primary care on CVD prevention and diagnosis from April 2022 which include a requirement to improve hypertension case-finding and diagnosis. This is where the largest undiagnosed prevalence gap remains and where the greatest reductions in premature mortality can be made.
An NHS spokesperson said: "Our national elective recovery plan sets out a comprehensive blueprint for tackling backlogs in care caused by the pandemic, and local teams are working hard to restore their cardiac services to pre-pandemic levels while maintaining a focus on preventing heart disease in the first place.
"Throughout the pandemic, the NHS has been open for patients needing urgent care for heart attack, stroke and other life-threatening conditions, and people should continue to come forward for help if they have symptoms or concerns about their health."
This article contains information from PA Media
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