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Questions answered by Dr. Charles Peniston, Cardiovascular Surgery Specialist, Chair of HVV’s Board of Directors.
All elective procedures stopped as the primary concern was to ensure the safety of the general population, in-patients, staff, and to ensure that services could be provided in a safe manner. The population of in-patients declined dramatically; many people were afraid of venturing outside or coming into contact with other members of the general population who could potentially be carriers. Trends were noticed globally that heart attack and stroke victims, as well as individuals with known heart conditions, were avoiding hospitals as they feared being infected with the virus. This was especially true at hospitals where the number of in-patients with COVID-19 were increasing. Most practitioners stopped seeing routine follow-up patients as we were dealing with a new disease and looking for the best ways to stop transmission and protect vulnerable patients. Hospitals were also concerned about preserving capacity for COVID-19 patients.
The number of patients who presented with acute symptoms initially diminished. Since then, there has been a slow and steady increase in the number of patients who are being evaluated for heart disease. At first, mainly the sickest patients were being seen as they were the ones who had serious enough symptoms to come to the Emergency Wards. Over time, patients who had learned to live with their symptoms have started to be seen for more elective procedures. Despite hospitals never being closed to urgent and emergent patients, there is still a backlog of patients who need evaluation. The patients who were undergoing procedures such as Transcatheter Aortic Valve Implantation (TAVI), Percutaneous Coronary Intervention (PCI), and heart surgery have been much more ill on average now that we’ve started seeing them again. This continues to be the case as we are doing procedures in patients who have a greater disease burden than we would usually see, highly likely due to repercussions of extended waits during the pandemic.
I believe that it is a combination of the initial decreased capacity, as well as a fear of contracting COVID-19 through contact with patients who may have the virus or be asymptomatic carriers. There was a lot to be learned about COVID-19 and I also think lingering fears that there would be insufficient personal protection equipment (PPE) made individuals feel like they shouldn’t go to the hospital unless absolutely necessary. Unfortunately, many symptoms of heart valve disease are subtle and can be mistaken as symptoms of other illnesses or merely ‘parts of ageing’. This reality only amplifies how many people may have stayed home instead of coming to the hospital, under the impression of saving PPE or not unnecessarily utilizing resources. In addition, it’s likely that when many hospitals introduced a no visitor policy, fewer people were inclined to get help as family members play a very important support role for patients, especially those with heart valve disease. Each hospital has its own policy, but at my hospital, the visitation policy is gradually being relaxed.
Heart valve disease is common, serious, but treatable. It is very important for patients to seek medical help if they develop symptoms, and this is especially true for patients with acute conditions or those experiencing a significant worsening of their symptoms. However, we also know that for patients with conditions such as aortic stenosis or heart failure, that their health will likely deteriorate over time if untreated. Therefore, it is very important to continue to seek medical help and advice. Hospitals and practitioners have put in place many safeguards to protect patients, family members, and staff. The rate of transmission of new COVID-19 cases in hospitals and practice settings is negligible at this point, so no one should fear visiting their doctor or the hospital.
They should not refrain from seeking medical advice. It is in the patient’s best interest for them to make appointments for new or worsening symptoms such as chest pain, shortness of breath, difficulty sleeping at night and leg swelling. Seeking advice is safe and could prevent further deterioration of their condition. Most importantly, the proper investigations and treatment will be recommended and carried out. It is very important to “just go” and seek medial advice.