The COVID-19 pandemic has sent shock waves through the healthcare system — along with every aspect of life in Canada. But how has it affected people living with heart conditions or stroke, and the healthcare resources they depend on?
That’s the question that a team of researchers across Canada, led by Heart & Stroke, set out to answer as the pandemic took hold around the world.
The resulting study was published July 15, 2020, in the Canadian Journal of Cardiology Open.
We asked Dr. Sharon Mulvagh, one of the co-authors, to explain this research. Dr. Mulvagh is a professor of cardiology at Dalhousie University and an emeritus professor at the Mayo Clinic.
What triggered this research?
During the pandemic, many countries saw a dramatic drop in the number of people seeking cardiac and stroke care. And we soon learned that underlying heart conditions and stroke increase the risk of complications from COVID-19. What was missing was global and Canadian data on the impacts on these populations.
We looked at the COVID-19 death rate as it relates to the size of a country’s population with cardiovascular disease (including stroke), and the extent of disruptions in scheduled procedures and surgeries.
We wanted to think about how big a backlog we were going to have in caring for those patients when we come around to what's being called “the new normal.” How could we use data to plan proactively for resuming the delivery of health care for our chronic disease population?
What were the results?
The study revealed the serious disruption to essential health care for people living with cardiovascular disease. Our analysis showed that more than 1,200 medical procedures, including coronary artery bypass surgery, angioplasty and valve surgery, were postponed each month in Ontario alone due to the impact of the pandemic.
So even for people who don't get COVID-19, changes in healthcare delivery systems in response to the crisis have impacted them.
We found that for every 1% increase in the proportion of a country’s population with heart conditions or stroke, the death rate from COVID-19 was 19% higher.
In countries like Canada, with more accessible health care, we have a higher proportion of people living with heart conditions and stroke. The COVID-19 death rate was found to be higher here than in countries with fewer healthcare services.
This interactive visualization shows the research findings. Click the boxes at left to see four aspects.
What can we learn from this research about restoring healthcare services?
We need to acknowledge that a strain has definitely been put on our healthcare resources in Canada because of the pandemic. I think that's self evident.
We always have to maintain emergency services and get the message across that people have to seek care for the acute cardiovascular symptoms, including stroke, that we have been educating about for a long time now.
For the elective type of care, there has to be a thoughtful plan as to how to reinstitute that. We have to have appropriate criteria to make sure that those patients that need care the most are getting it.
We also have to recognize that our healthcare providers are under a lot of stress. Encouraging self care and wellness for everyone is important, but particularly for our healthcare providers.
This study provides contrast to another Heart & Stroke paper you worked on, published a few weeks earlier. Tell us about that.
In that pre-pandemic baseline study, we looked at the trends in hospitalization rates for heart conditions, stroke and vascular cognitive impairment (VCI) over 10 years (2007-2016).
Hospitalization rates decreased for several conditions. But we saw growth in VCI, likely due to our aging population. Shockingly, we found some conditions happening more often in younger people, such as heart failure in people age 20-39. And in younger women (age 20-39), we saw an increase in hospitalization because of heart valve disease and stroke.
It was an important aspect of the research to recognize which of the conditions were relatively increasing or decreasing. Another was to recognize that there were unique features of the population affected by these conditions based on age, sex, and geography.
To really focus on caring for yourself is the best way to gain control.
Our observations led to recommendations that we should be more holistic in our approach. Traditionally we have put care into silos — the neurologists take care of the strokes and the cardiologists take care of the heart attacks. But really we're all connected.
And integration of care becomes even more critical when healthcare resources are scarce as a result of the pandemic.
How did this study lay the groundwork for the COVID-19 research?
It's very useful to have a pre-pandemic baseline.
It's going to be important for us to carefully monitor this as we go forward. For example, we noted that coronary artery disease hospitalizations were decreasing. Well, are they going to increase now?
Perhaps those patients that didn't come to the hospital acutely, because of the fear of COVID-19, will end up with more chronic illness down the road.
What would you say to a person who has a heart condition or has had a stroke? How has the pandemic changed the outlook?
I think it just underscores all the things that we have been saying for a long time. The individual choices that a person can make will impact greatly on their disease process — even, or perhaps especially, during a pandemic.
In other words, follow through on the recommended nutritional and physical activity guidelines. Take your medications as prescribed. Monitor your vital signs as advised, such as your blood pressure. To really focus on caring for yourself is the best way to gain control in a situation where you feel like you have no control.
What does Heart & Stroke bring to this research?
As a clinician, you see the patient in front of you and you have ideas about how to make things better. But you're just one person.
It takes a large infrastructure to access data, interpret data, engage clinicians to help with that interpretation, then take that information and turn it into scientific papers, educational programs and messages to improve cardiovascular care.
Heart & Stroke has the infrastructure to accomplish all of that, and it has been a unique opportunity to collaborate on this important and evolving work.