Deaths from ischemic heart disease and hypertensive disease in the U.S. increased during the COVID-19 pandemic over the prior year, while globally, COVID-19 was associated with significant disruptions in cardiovascular disease testing, according to two studies published Jan. 11 in the Journal of the American College of Cardiology.

In the first study, Rishi K. Wadhera, MD, MPP, MPhil, et al., examined whether population-level deaths due to cardiovascular causes changed in the U.S. during the early phase of the pandemic, relative to the same period in the year prior, and if these changes were more pronounced in states that experienced the initial surge of COVID-19 cases.

Using data from the National Center for Health Statistics, researchers looked at death rates from cardiovascular causes in the U.S. from March 18, 2020 – June 2, 2020 (the pandemic) and Jan. 1, 2020 – March 17, 2020 (before the pandemic) and compared them to the same periods in 2019.

Data showed that deaths from ischemic heart disease and hypertensive diseases increased after the onset of the pandemic in 2020, compared with changes over the same period in 2019. In contrast, deaths caused by heart failure, cerebrovascular disease or other diseases of the circulatory system did not change nationally. New York City experienced the largest relative increase in deaths due to ischemic heart disease (139%) and hypertensive diseases (164%) during the pandemic. The remainder of New York state, New Jersey, Michigan and Illinois also experienced significant increases in deaths due to these conditions, while Massachusetts and Louisiana did not see a change in cardiovascular deaths.

"Our findings suggest that the pandemic may have had an indirect toll on patients with cardiovascular disease, possibly owing to the avoidance of hospitals because of concerns about exposure to the virus, increased strain on health care systems, and deferred outpatient and procedural care," write the authors of the study.

"[Prolonged] delays in outpatient testing, procedures, and follow-up may impose unanticipated burdens on the access to and delivery of care with uncertain long-term implications," write Michael N. Young, MD, et al., in an accompanying editorial comment. The authors further discuss attribution of death in the COVID era; a reminder of the natural history of untreated cardiovascular disease; considerations for governance, health policy, and public messaging; and identification and protection of vulnerable peoples.

In a second study, Andrew J. Einstein, MD, PhD, FACC, et al., sought to determine the full magnitude of reductions in diagnostic cardiovascular disease procedures in 2020 and how that might impact long-term cardiovascular disease outcomes.

Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures in 108 countries. According to researchers, procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Specifically, transthoracic echocardiography decreased by 59%, transesophageal echocardiography by 76%, and stress tests by 78%. Coronary angiography (invasive or computed tomography) decreased 55%. Researchers also classified countries into four economic levels (low, lower-middle, upper-middle and high) and found that location in a low/lower-middle income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.

"[These findings] raise serious concerns for long-term adverse cardiovascular health outcomes resulting from decreased diagnosis," write the authors of the study. "Efforts to improve timely patient access to cardiovascular diagnosis in this and future pandemics, particularly in low- and middle-income countries, are warranted."

In an accompanying editorial comment, Darryl P. Leong, MBBS, PhD, et al., discuss how this research can help with broader health system issues during the second or future waves of the COVID-19 pandemic. The authors note that "the overwhelming priority should be emphasizing the importance of public health measures to prevent the spread of COVID-19."

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Acute Heart Failure, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension

Keywords: ACC International, Pandemics, COVID-19, Cardiovascular Diseases, Exercise Test, Coronary Angiography, Public Health, National Center for Health Statistics, U.S., Outpatients, Echocardiography, Transesophageal, Inpatients, Personal Protective Equipment, Developing Countries, Follow-Up Studies, Hypertension, Echocardiography, Cardiovascular System, Telemedicine, Heart Failure, Cardiology, Myocardial Ischemia, Cerebrovascular Disorders, Health Policy, Hospitals, Outcome Assessment, Health Care, Tomography

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