While acute cardiovascular problems have gone down during the pandemic, deaths from cardiovascular disease went up in some regions across the U.S. Rishi Wadhera, MD (Cardiology, BIDMC) shared how there are likely several reasons to this, the first, and most concerning, is that patients with cardiovascular conditions avoided seeking care at hospitals due to fear of contracting the virus.

Yahoo! Life – January 13, 2021

Why deaths from cardiovascular disease have risen during the pandemic

Although hospitalizations for acute cardiovascular problems have gone down during the pandemic, deaths from cardiovascular disease went up in some regions across the U.S., a new study has found.

The researchers say that may be due to patients putting off going to hospitals over fears of contracting COVID-19.

For the study, which was published in the Journal of the American College of Cardiology, researchers evaluated death rates from cardiovascular causes in the months leading up to the pandemic in the U.S. (Jan. 1, 2020 to March 17, 2020) and after the start of the pandemic (March 18, 2020, to June 2, 2020). The data was also compared to cardiovascular death rates during the same time periods in 2019.

There were nearly 400,000 cardiovascular deaths from Jan. 1, 2020, to June 2, 2020. According to the study, deaths caused by ischemic heart disease increased across the country after the start of the pandemic in 2020, compared to the same time period last year. Deaths caused by hypertensive disease also went up, but the rates did not go up for heart failure, cerebrovascular disease and other circulatory system diseases.

New York City in particular had “a large relative increase” in deaths caused by ischemic heart disease and hypertensive diseases during the pandemic, according to the study. There was a “more modest” increase in deaths caused by the same conditions in the rest of New York State, as well as New Jersey, Michigan, and Illinois, but not in Massachusetts or Louisiana.

Why did death rates of cardiovascular disease go up during the pandemic?

Study author Dr. Rishi Wadhera, cardiologist at Beth Israel Deaconess Medical Center and Harvard Medical School, tells Yahoo Life that there are likely several reasons why cardiovascular deaths increased during the early phase of the pandemic in the U.S. “The first, and most concerning, is that patients with cardiovascular conditions like heart attacks — which typically require emergent treatment — avoided seeking care at hospitals due to fear of contracting the virus,” Wadhera says.

“In addition, patients with cardiovascular conditions may have faced challenges in accessing timely care, or experienced delays in receiving important cardiovascular procedures, simply because hospitals in hard-hit regions were really overwhelmed and strained,” says Wadhera. “Finally, it’s possible that some of these deaths reflect the cardiovascular complications of undiagnosed COVID-19, because testing was quite limited during the initial surge of cases in the U.S.”

Dr. Salim Virani, professor of medicine specializing in cardiology at Baylor College of Medicine, tells Yahoo Life that some cardiovascular disease patients may have been “wary” about going to hospitals after getting the message that people, especially older people and those with pre-existing health conditions, should stay home. “They may have delayed care that they otherwise would have sought,” Virani says. “That seems to be the most plausible cause here.”

Dr. Ragavendra Baliga, a cardiologist who specializes in advanced heart failure at the Ohio State University Wexner Medical Center, tells Yahoo Life that in hard-hit areas like New York City, some doctors had to cut back on routine surveillance of preventable risk factors, which may have been another factor. Bagila says, “Access to health care is one big issue because of the allocation of scarce resources” during the pandemic. “Many people are on the edge of risk and not having access to health care [may have] tipped them over to the wrong side.”

Virani agrees, saying, “Hospitals are already constrained in terms of material resources and human resources — doctors, nurses. They may not be able to give their 100 percent to patients who may have nonCOVID-related emergencies. Other specialists were pulled into taking care of patients with COVID and very rightly so since that was and is the need of the day.”

Baliga also points out that mental health — people dealing with “more anxiety, depression and fearfulness,” as well as loneliness during the pandemic — is another possible factor. “Generally speaking,” Baliga says, “mental health does add to cardiovascular disease” risk.

Experts stress not to put off medical care

Baliga says the study serves as a “big eye opener” for both doctors and patients, adding, “It is so important to continue to seek medical care” during the pandemic. He says that even seemingly modest increases in blood pressure, such as going from 120 millimeters to 140 mm in systolic blood pressure (the top number), can put a patient’s health at risk. With “an increase in blood pressure of even 20 points, the risk of heart disease death and stroke death doubles,” says Baliga. “That increase makes a big difference.”

That’s why it’s important for patients with cardiovascular disease to be in close contact with their physicians, says Virani. “Make sure if you’re not seeing your provider in person, be in touch with them, talk to them, discuss with them what symptoms you’re having, refill your prescriptions, and be very open with your symptoms,” he says. “Do not minimize your symptoms with your provider.”

Virani also stresses that “it’s safe to go to a hospital in an emergency,” adding, “Do not defer care, or ‘Let me just stay home with this chest pain tonight.’ Tomorrow morning may never arrive for you. If you’ve got an emergency, it should be dealt with the same way now as it was pre-pandemic. Do not defer calling 911.”

Wadhera agrees, saying: “It’s so important that anyone experiencing symptoms of a heart attack or stroke — or other concerning symptoms — seek medical care. Hospitals are very safe environments, even in the midst of this public health emergency.”