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Cardiovascular Health 2021

Delay in seeking help risks poor outcomes

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Professor Simon Ray

President, British Cardiovascular Society

COVID-19 has placed a major strain on hospitals but, thanks to the efforts of NHS staff, emergency treatment for heart attacks and other heart diseases has continued uninterrupted.  

Early on in the pandemic cardiologists across Europe reported seeing a large fall in patients being treated for heart attacks. Similar patterns were reported for stroke and for heart failure.

Increase in potentially avoidable deaths

Delays in or avoidance of seeking help can have severe consequences. The reduction in hospital admissions has been accompanied by an increase in deaths from heart attack, heart failure and stroke to well above pre-COVID levels, with most of these deaths occurring in the community.  

There has also been an increase in people suffering a cardiac arrest out of hospital, likely due in part to a reluctance to call for help for chest pains. Some of these excess deaths would have been avoidable with prompt treatment. 

People with severe chest pains, shortness of breath or symptoms of a stroke should call 999, just as before the pandemic.

The importance of calling for help

It is understandable that the public are worried about calling for help during a pandemic, but the message is clear that non-COVID emergencies remain emergencies. The risk of not calling for help far outweighs the risk of contracting severe COVID infection in hospital.  

People with severe chest pains, shortness of breath or symptoms of a stroke should call 999, just as before the pandemic. These are time critical illnesses and need to be treated as rapidly as possible. People arriving in hospital with these symptoms will be assessed and treated as they were before COVID. 

Dealing with the backlog

The pandemic has meant that non urgent care for heart disease has been delayed. Patients have been reluctant to see their GP and there has been a reduction both in the number of heart tests requested by GPs and in the number of referrals to hospital.  

In hospitals, staff and facilities have been diverted to dealing with emergencies and unwell COVID patients. As a result, fewer non urgent procedures have been done, particularly in cardiac surgery. All of this has created a backlog that will take considerable time and effort to work through.  

Each NHS region is putting in place plans to deal with this, using lessons learned during COVID about the importance of collaboration between hospitals. Remote consultations are replacing many face to face review appointments and other technologies are assisting patients to monitor and manage their own conditions in the community. 

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