Learning from the Past as COVID-19 Continues in Canada

November 1, 2020

As COVID-19 case numbers continue to cause uncertainty and changes in Canada, it is important that we apply our learned lessons from the country’s initial response to the pandemic. Heart Valve Voice Canada is endorsing a three-point plan developed by our UK partner as a step toward changing how we manage heart valve disease amid this second wave.

Last Spring, tens of thousands of elective procedures were cancelled or postponed out of precaution for preserving hospital space. This resulted in less patients in hospitals, and also meant fewer patients sought medical care due to fear of contracting COVID-19 in the hospital. Now, our health care systems are facing an increased backlog of patients, including those needing heart valve surgeries or procedures, and we are seeing even sicker patients because of these delays.

Our colleagues in the UK surveyed cardiac clinicians at the height of the COVID-19 outbreak to understand how they responded to the added challenges the pandemic placed on their job. They found that 73 per cent of clinicians saw a reduction in primary care referrals for heart valve disease during this time, and 93 per cent believe this was due to patients’ fear of COVID-19. We know anecdotally that clinicians had a similar experience here in Canada.

As we navigate the second wave of COVID-19 in Canada, we support and recommend the three-point plan that HVV UK developed to prevent even further delays and sicker patients as the pandemic continues. This three-point plan includes:

1. When your heart says so, just go!

It is very important to listen to your heart and seek medical attention if you’ve begun to show new heart valve disease symptoms, or if your symptoms have changed or worsened. Even amid rising case numbers, it is crucial that heart valve disease patients prioritize their health by immediately seeking medical attention. Any delay in responding to deterioration in your symptoms could be life-threatening and we urge you to set aside fear about seeking help due to COVID-19. Our medical centres are well prepared to treat patients and have plans in place that acknowledge their unique circumstances and capacities. Our understanding of the virus and the ability to properly contain it within hospitals has significantly increased since the initial outbreak earlier this year. Patients should feel safe seeking medical attention and continue to take preventative measures, like wearing a mask and washing hands, to help protect against exposure to the virus.

2. Refer patients

Physicians should continue to refer those with symptoms of heart valve disease to secondary care. Cardiac clinics and care teams are prepared to receive, diagnose, and treat patients and have proper protocols in place to maintain separation from COVID-19 patients. Family physicians should continue to support a timely and smooth transition from primary care to secondary care teams, as delays in treatment merely lead to worse outcomes and sicker patients. Again, our learnings in the first wave of the pandemic mean that our system has significantly improved its capacity and processes for caring for heart valve disease patients. Primary care physicians need to have the confidence to refer and help us reduce further backlogs in referrals.

3. Reassess treatment options

Cardiology teams can assess and determine if a less-invasive procedure is an appropriate treatment pathway. Minimally invasive procedures require patients to stay in the hospital for less time, do not require intensive care, can support increased capacity in hospitals, and allows treatment of even more patients which further reduces backlogs. Adjusting or changing treatment plans will only be suggested if it will result in a better overall outcome and balanced or less risk for patients.

Learning from the first wave of the pandemic will require heightened alert and changes across the full heart valve disease community, from patients and their caregivers to family physicians to specialized cardiac care teams. Together, we can put our COVID-19 fears aside and ensure timely, appropriate care for those living with heart valve disease during and beyond this second wave.

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