As we round the corner into year three of the COVID‑19 pandemic, researchers continue to gain insights into the magnitude of health complications caused by the SARS-CoV-2 virus. Several studies indicate that for many individuals, COVID‑19 is much more than a respiratory infection and that the virus is responsible for a wide range of both short- and long-term health issues. Chief among these are several cardiovascular complications, including:
- Blood clots.
- Arrhythmias.
- Myocarditis.
- Heart failure.
As Cleveland Clinic cardiologist and biostatistician Larisa Tereshchenko recently told Science magazine, “In the post-COVID era, COVID might become the highest risk factor for cardiovascular outcomes.”
Increased Risks Lead to Lasting Impacts
Myocarditis, for example, is an inflammation of the heart muscle often caused by a viral infection and can be dangerous or life threatening if left untreated. In September 2021 the Centers for Disease Control and Prevention (CDC) published a study in which researchers found a 42% increase in myocarditis inpatient diagnoses in 2020 as compared to 2019. The study also reported that individuals with a COVID‑19 infection were 16 times more likely to be diagnosed with myocarditis and that COVID‑19 is a strong and significant risk factor for the condition. According to the American Heart Association, “A growing number of studies suggest many COVID‑19 survivors experience some type of heart damage, even if they didn’t have underlying heart disease and weren’t sick enough to be hospitalized.” Another study by Liu et al. noted that 44% of patients with COVID‑19 who were admitted to an ICU reported experiencing heart palpitations.
Nearly 60% of Americans have been infected with COVID‑19, according to the CDC. While it remains unknown if cardiovascular damage from COVID‑19 will heal over time or manifest to a greater extent in the future, the increase in cardiovascular risk across such a large percentage of the US population prompts consideration of the lasting impacts on the healthcare system from an operational and care delivery perspective. COVID-19 has already had a significant impact on hospitals, health systems and providers, and it seems highly probably that cardiovascular operations and care delivery, in particular, will continue to be affected for the foreseeable future. Given the magnitude of the situation, specific trends and lessons learned during the pandemic begin to emerge. Figure 1 outlines six ways the pandemic is likely to influence cardiovascular care delivery going forward.
The Future Is Now
Cardiovascular disease remains the leading cause of death worldwide, and the growing demand created by cardiac sequelae from COVID-19 will create an even greater strain on demand and supply for cardiovascular care. The American College of Cardiology recently published an expert consensus decision pathway to provide a framework for evaluation and management of adults with cardiovascular sequelae following SARS-CoV-2 infection. Tools such as this will assist CV leaders in preparing for an increase in ancillary testing, including non-invasive cardiac imaging, and new clinical protocols.
As we have learned through one of the greatest tolls of the pandemic, cardiovascular care should not be considered elective and must not be delayed. At a time when capacity is strained, cardiovascular program leaders will need to focus on improving the efficiency of operations and leverage technology to optimize capacity. Shifting more volume to telehealth and designing regional health system partnerships to allow for sharing of data and clinician resources are examples of potential strategies. The cardiovascular care team, which has experienced unprecedented levels of stress and burnout, is our most valuable asset in managing the longer-term impact of COVID-19 on cardiovascular health. So as program leaders design these strategies, they will need to invest thoughtfully in tools, technologies, partnerships, and resources that mitigate, rather than worsen clinician stress and burnout—the future of our health system depends on it.
Published April 27, 2022