Catch up on heart care delayed during the pandemic

Delayed health care, both preventive and diagnostic, is an area where we are still seeing a lasting impact from the pandemic.

And heart care was one of the most commonly delayed preventive services due to COVID-19. According to the American College of Cardiology, treatments of heart attack and stroke declined during the pandemic, and deaths increased.

Over the past two years, Margo Kozinski, MD, a cardiovascular physician, and her colleagues at PeaceHealth in Vancouver, Washington, have seen the pandemic’s impact up close.

“In the beginning, we saw a significant drop in heart attacks presenting to the hospitals for treatment. Patients were afraid to come into the hospital due to the perceived risk of catching or spreading COVID-19,” she said. “As a result, they were presenting with more advanced disease or not seeking treatment at all. Overall, we saw a significant decrease in cardiovascular procedures being performed.”

Now, two years later, many medical centers and cardiovascular providers are seeing the number of heart patients return to pre-pandemic levels. They’re also seeing more advanced cases of heart disease.

Surviving a heart attack at home doesn’t mean everything is OK. In fact, the longer someone waits after a known or suspected attack, the harder it is to repair the damage.

“We have seen people with potentially lethal complications of untreated heart attacks, including rupture of interventricular septum and acute severe mitral valve regurgitation (leaky mitral valve) because care has been delayed,” she noted.

A majority of patients being seen now are between 40-80 years of age, which is normal. However, “we have seen people in their 30s and even 20s—a lot driven by risk factors—especially smoking.”

Pandemic-related increases

Increased pandemic-related stress, lack of exercise and poor nutrition have also led to additional cardiac health concerns.

Closed gyms and indoor workout spaces made it difficult for people to exercise safely. “In the beginning of the pandemic, cardiac rehab programs weren’t open and that significantly affected how well people recovered from heart attacks, heart failure or cardiac procedures” said Dr. Kozinski. “A lot of patients were missing the benefits of exercise.”

High levels of stress caused many people to seek comfort from food—potentially overindulging or opting for unhealthy choices. Similarly, tobacco, alcohol and other substances were also an attractive—yet ultimately unhelpful—means of coping.

Lockdown loneliness, separation from loved ones, isolation and workplace anxiety have also been major factors. And COVID-19 itself has also shown up in “long COVID,” clotting, myocarditis and other problems that need careful management.

Have you put off care in the past several months? Consider taking stock of your heart health now.

Symptoms? Get care now.

If you have experienced or are experiencing any symptoms such as chest pain or shortness of breath, seek care right away. Read more about symptoms of heart attack and stroke.

“Don’t wait!” said Dr. Kozinski. “The sooner your heart can be checked out, the sooner treatment can be started to prevent further damage and possibly restore function.”

No symptoms? Consider these screenings.

If you don’t have symptoms, ask your primary care doctor about being screened for these five main contributors to heart disease:

1. Family history. You can’t do anything to change this risk factor; however, it is an important part of helping your doctor understand what to look for. Did your dad require a heart valve replacement? Did your maternal grandmother die of a stroke? How old were they when they were diagnosed? This detail gives you and your doctor a better chance of taking meaningful action to potentially prevent, identify or treat issues early.

2. Hypertension. Your blood pressure is typically taken at every medical or dental appointment. If your blood pressure is consistently too high, your doctor might recommend you regularly monitor it at home. Talk with your provider about setting a personal goal for your readings and ways to reduce or manage your hypertension.

3. Diabetes.  Do you have diabetes (or pre-diabetes)? Experts encourage adults aged 40-70 who are overweight have a screening for diabetes every three years. Diabetes has serious and far-reaching implications for overall health, including your heart. If you have diabetes, work closely with your provider to manage the condition with medications and/or lifestyle practices.

4. Hyperlipidemia. Too much cholesterol can lead to the buildup of plaque inside your arteries. It can also make your arteries hard or stiff. These can reduce or block the flow of blood to your heart or brain. Be sure to get a baseline reading of your cholesterol levels and ask your doctor to recommend ways to keep your cholesterol under control.

5. Smoking. Smoking tobacco—especially cigarettes—increases your risk for many diseases, including heart disease and stroke. When you read how your body responds to smoking, you can understand why. Among other things, smoking makes your blood more “sticky” which can lead to clots or clogs. It also reduces the oxygen available in your bloodstream and can disrupt the rhythm of your heartbeat. Use this tool to see if you are ready to quit smoking.

Screenings like those above are the first line of defense for identifying the potential for or actual presence of heart disease.

It's critical to get heart screenings done regularly, said Dr. Kozinski. If your risk is relatively low, visit your provider at least once a year.

If you have diabetes or other conditions that put you at higher risk, plan to see your provider as often as you need to bring your risks down. And take active steps to care for your overall health: 

• Exercise or move every day without overexerting. Try 20 minutes of walking.
• Maintain a healthy body weight.
• Eat a whole food plant-based diet.
• Manage mental and emotional stress.
• Quit smoking. If you can’t quit altogether, try cutting down on how much you smoke.

Schedule an appointment with your PCP or a PeaceHealth cardiologist if you have concerns about your heart.

In the event you need additional care for your heart, our teams of expert cardiologists can help develop a plan that works for you.