by:
Lilian Mbau
A lot has been discussed about the interaction between coronavirus disease of 2019 (COVID-19) and Cardiovascular Diseases (CVDs) with more focus on the effect of COVID-19 on patients with CVDs as well as the cardiovascular (CV) complications resulting from COVID-19 infection. Patients with underlying conditions such as CVD or associated risk factors have increased mortality from COVID-19 infection (European Society of cardiology, 2020). Covid-19 infection on the other hand has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias and venous thromboembolism (Xiong et al., 2020).
It is however important that we also focus on the implications of the pandemic on CVD patients without COVID-19 infection. It is estimated that up to 80% of elective admissions and procedures in most countries have been postponed (Gori et al., 2020). In addition, in some countries there has been a drop of up to 30% of visits to the emergency departments (Gori et al., 2020). A study carried out in Hongkong, China looking at the effect of COVID-19 on Acute ST-segment–elevation myocardial infarction (STEMI) patients seeking care at one of the treatment centers found an increase in time from onset of symptoms to seeking medical care as well as an increase in the time from arrival to the hospital to the completion primary percutaneous coronary intervention (PPCI).
Not seeking care or delays in seeking care can result in negative outcomes especially among patients with CVDs and other chronic illnesses. Patients with CVDs and other comorbidities have been made aware of their increased risk of infection as well as the poorer outcomes. They have been urged to take more seriously hygiene and social distancing measures. The European Society of Cardiology (ESC) recommends patients with hypertension to monitor their blood pressure at home and receive videoconference and telephone consultation as required (European Society of cardiology, 2020). The American College of Cardiology recommends that in-person clinic visits should be replaced with telehealth visits in areas with active COVID-19 to minimize nosocomial infections (ACC, 2020). The risk of these recommendations occurs when patients are not adequately able to monitor their conditions at home or are not educated on when they should seek care.
The impact of COVID-19 on health outcomes of chronic disease patients in low- and middle-income countries (LMIC) may be worse. A significant proportion of these patients are often poorly managed due to inability to access quality health services including affordable medication. In addition, due to poor health seeking behavior and competing priorities, patients with chronic disease such as hypertension tend to stop their medication when they feel better and even abandon their routine clinic visits altogether. Poor health accessibility brought about by the COVID-19 pandemic is likely to worsen the situation resulting in poorer outcomes (Kretchy et al., 2020). It is also likely that the global restriction in imports and exports will affect supply of medication for chronic diseases resulting in shortages and subsequent increase in cost.
In Kenya for example, as soon as the initial patients with COVID-19 were diagnosed, a number of both private and public CVD and other routine clinics rushed to close requiring patients who needed care to visit the accident and emergency department or consult the doctor through their mobile phones. Some private practices and hospitals were able to quickly put in place telemedicine and drug delivery services however majority of Kenyans seeking care in the public hospitals were left out. Several public hospitals are reporting significant decline in both acute and chronic care visits. Cognizant of the danger many chronic disease patients were exposed to by restrictions in access to health services, the Ministry of Health issued a directive to all health facilities in the public sector to ensure services for patients with non-communicable diseases such as hypertension and diabetes clinics remain open.
The true impact of the pandemic on CVD care will become evident after the containment of the pandemic. It is however important that as policy makers put in place measure to contain the infection, they take into consideration the effect of these measure on delivery of routine services especially for chronic disease patients (Tam et al., 2020).
The Heart in the Time of COVID-19 