Q&A: Cardiologist discusses COVID-19 and its impact on patient care

COVID-19, especially the omicron variant, is still surging through the United States, putting a tremendous strain on the nation’s healthcare systems.

Some patients with COVID-19, we've learned, can encounter heart problems. SARS-CoV-2, the virus that causes COVID-19, may directly infect heart cells, impact blood vessels or contribute to abnormal blood clotting, according to the National Heart, Lung, and Blood Institute. 

Also, the CDC points out, patients with underlying cardiac conditions such as heart failure and coronary artery disease are at a higher risk for developing severe disease.

In addition, a recent study published in the Journal of the American Heart Association showed that hospitalized COVID-19 patients with myocardial injury have an increased risk of developing adverse outcomes. Even mild and moderate cases of COVID-19 can impact a patient’s heart and cardiovascular system, according to another recent analysis

What's the latest news on this ongoing pandemic? How are cardiologists coping with rising COVID-19 cases and over-crowded, understaffed hospitals?

Eric Stecker, MD, MPH, an electrophysiologist at Oregon Health & Science University and chair of the American College of Cardiologist’s Science and Quality Committee, addressed those questions, and others, in an exclusive interview with Cardiovascular Business.

Stecker HeadshotBased on everything you've seen, which COVID-19 patients face the highest risk for cardiac problems?

Eric Stecker: The answer to this question is actually involved with related questions. The first is, what is the risk of death from acute COVID-19 among patients with cardiovascular disease? This is significantly driven by older age, severity of underlying heart disease, male gender and a variety of other coexisting health factors. And, unfortunately, the socioeconomic determinants of health such as poverty, racial/ethnic minority, etc. that strongly influence overall mortality appear to also influence COVID-related mortality.

The second related question is, who is at a high risk of experiencing cardiovascular adverse events or cardiovascular death with acute COVID-19? One of the most important issues to recognize is that a large risk for cardiac problems occurs when people delay or defer care. Over the course of the pandemic, many people have had fatal heart attacks, cardiac arrest or other major cardiac events because they ignored symptoms or did not see their doctor for routine visits for prevention, evaluation and treatment.

There are, of course, also significant cardiovascular risks among people with active COVID-19. These are generally related to the severity of the underlying cardiovascular disease prior to COVID as well as the severity of COVID illness, and other pre-existing health problems.

How has COVID-19 impacted burnout among cardiologists?

I can say that the overall American healthcare workforce has been very negatively impacted by the pandemic. Not just physicians, but nurses, nurse practitioners, physician assistants and many others who work to care for patients are experiencing burnout.

Most cardiologists are less directly impacted by having to care for large numbers of patients with COVID-19 daily. However, they can be indirectly impacted by the inability to offer their usual level of high-quality care for procedures when hospitals are overburdened with patients admitted for COVID. And even the routine functioning of cardiology clinics and inpatient consultative services are severely impacted when key personnel quit or are not able to come to work due to COVID-19.

Almost two years into the pandemic, how is cardiac care being impacted? 

Fortunately, our ability to sustain traditional high-quality cardiovascular care and the average patient's understanding of the importance of seeking both routine and acute cardiovascular care are both much better than at the very beginning of the pandemic. Nonetheless, we must be vigilant and use the lessons learned from the earlier days to prevent backsliding. This is a substantial risk with the current omicron wave coming during the winter, when hospital capacity in many parts of the country is already routinely limited.

 

 

What are the most common COVID-19-related heart conditions we are seeing in children and young adults? 

Again, fortunately, the risk of serious problems among children and young adults is very low. But keep in mind, this should not in any way minimize the experience of any individual who has severe illness or the risk for certain children and young adults who are at higher risk due to other underlying severe conditions. Of the rare conditions, myocarditis from COVID-19 infection is one to be aware of. It is typically very mild and self-resolving. It can also occur after vaccination of adolescent boys and young adult males, though the risk from vaccination is much lower than the risk from infection. Severe myocarditis requiring medications to support heart function or causing dangerous arrhythmias is exceedingly rare among children and young adults. There are other inflammatory conditions, and blood clotting conditions that can occur with severe acute viral illnesses, and very rarely occur with COVID-19 in children.                                       

What new treatment options/procedures have been implemented during the pandemic that improved outcomes for patients with COVID-19? 

There are many medications and critical care strategies that have improved outcomes for patients with COVID-19, though those are not specifically cardiac. Cardiologists do play a role in supportive treatment for cardiovascular complications among patients with COVID-19, including arrhythmias, heart attacks and heart failure. One critical therapy that cardiologists and cardiac surgeons offer to support the sickest of COVID-19 patients is the use of ECMO, or extracorporeal membrane oxygenation. This is a surgical procedure to connect the patient to an external device that can provide oxygenation outside the body for patients with severe lung injury and can temporarily take over when cardiac pumping function fails.

Also, for patients with less severe COVID-19 or after recovery from severe COVID-19, cardiologists play an important role in helping what is called "long haul COVID.” Cardiologists are also helping determine when it is safe for a patient to resume normal exercise or competitive athletics.

Click here to view the American College of Cardiology's COVID-19 hub. 

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