Where are the cardiology patients?
The prospect of a trip to the Emergency Room can be frightening, even in normal times, but now a fear of COVID-19 has heightened that response to a level that has cardiologists worried. A study of nine major hospitals, including two in Massachusetts, revealed that the number of severe heart attacks being treated since the COVID-19 outbreak began in the U.S. has dropped 38 percent.
The decrease in hospital visits is concerning doctors because, with the additional psychosocial pressures of stress and isolation that are being caused by COVID-19, it would seem to make more sense if the numbers were higher than usual, not lower.
One theory floated by Biykem Bozkurt, president of the Heart Failure Society of America, is that cardiovascular patients are afraid to go into what feels like a hotbed of virus activity. This is especially true because it has been frequently reported in the news that patients with heart disease or hypertension have a higher risk of dying if infected with the coronavirus.
Even though Cardiologist Lawrence McAuliffe, MD, of the Cape Cod Healthcare Cardiovascular Center in Hyannis, understands people’s concerns, the alternative possibility – a severe treatable cardiovascular condition – should outweigh their fears.
The Cape Cod Hospital and Falmouth Hospital ERs are very well prepared to triage patients as to what their presenting issues and symptoms are, he said.
“They can immediately identify if it is a COVID-19-related issue, in which case they get appropriate protection for both patient and staff, or if it clearly is a non-COVID patient,” he said.
Ignoring warning symptoms of a heart attack or stroke, and delaying care, poses a significant risk to your heart or brain, Dr. McAuliffe said.
“The basic message would be: Pretend there is no COVID-19, if you’ve got an issue that needs intervention or treatment,” he said. “We want to hear about any symptom that you would otherwise feel needs attention or an answer.”
Call 911 for These Symptoms
- For those with an established cardiovascular issue, any return of symptoms you’ve had in the past
- Chest discomfort
- Shortness of breath
- Heart palpitations
- Tachycardia (a fast heart rate over 100 beats per minute)
- Fainting or near fainting
- Stroke symptoms (face drooping, arm weakness, slurred speech)
Patients with less severe symptoms should also stay in touch with their healthcare provider, whether it is a primary care physician or a specialist. Offices are open and staffed for daytime business and 24/7 calls. Most appointments are being done over the telephone or with audio/video virtual visits, but some cardiac patients may need more hands-on care.
On a recent day, Dr. McAuliffe took care of 20 patients, with only five of them actually coming into the office. Patients who need in-person visits include:
- Anyone who needs an EKG to establish heart rate and rhythm.
- Some patients with heart failure.
- Some patients with valve issues.
- Patients who have recently been discharged from the hospital with a cardiovascular issue.
- Patients who have been recently discharged from the hospital for a non-cardiovascular issue who developed cardiovascular complications.
That could include someone who had COVID-19. Most people think of COVID-19 as a respiratory illness, but now doctors are recognizing that it can harm the heart and other organs.
“Once COVID-19 is established, there can be blood clotting issues where they become hypercoagulable and can have blood clots that travel, causing strokes or kidney or lower extremity vascular issues,” Dr. McAuliffe said. “There can be inflammation of blood vessels themselves - sort of a vasculitis, or chest discomfort. It can masquerade as just about anything in terms of symptoms and you can actually have significant cardiovascular issues and consequences.”
While Italy was having the dramatic surge in COVID-19 cases, the highest percentage of healthcare workers to get sick and even die were cardiovascular physicians and nurses, Dr. McAuliffe said. The reason was that the patients were not presenting with pneumonia-like symptoms, they were presenting with chest discomfort and cardiovascular symptoms.
Because of the experiences in Italy and other countries, like China, doctors in the U.S. now know to watch for this different presentation. Emergency Room physicians know to assess cardiovascular patients, so they know whether the symptoms are truly unrelated to COVID-19 or if they are a COVID-19 co-presentation, meaning they are part of the symptoms of COVID-19.
“It doesn’t matter if you are having a heart attack with or without COVID-19,” Dr. McAuliffe said. “Either way it needs to be addressed.”