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Review
. 2023 Jun;39(6):716-725.
doi: 10.1016/j.cjca.2022.11.014. Epub 2022 Dec 5.

Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner

Finlay A McAlister  1 , Harsh Parikh  2 , Douglas S Lee  3 , Harindra C Wijeysundera  4
Affiliations
Review

Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner

Finlay A McAlister et al. Can J Cardiol. 2023 Jun.

Abstract
in English, French

There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial increase in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this report, we review the direct effect of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect effects of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic effects on health care systems and particularly the care deficits caused (or exacerbated) by health care delayed or foregone during the COVID-19 pandemic. We review the consequences of: (1) deferred/delayed acute care for urgent conditions; (2) the shift to virtual provision of outpatient care; (3) shortages of drugs and devices, and reduced access to: (4) diagnostic testing, (5) cardiac rehabilitation, and (6) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.

Durant la pandémie de COVID-19, les taux de surmorbidité et de surmortalité étaient considérables, mais pas toujours directement attribuables à l’infection par le SRAS-CoV-2, et de nombreux décès non liés à la COVID-19 étaient d’origine cardiovasculaire. La pandémie a eu de graves effets indirects qui ont augmenté sensiblement le fardeau des maladies vasculaires et les facteurs de risque cardiovasculaire, aussi bien chez les personnes qui ont survécu à une infection par le SRAS-CoV-2 que chez celles qui n’ont jamais contracté le virus. Nous examinons ici l’effet direct de l’infection par le SRAS-CoV-2 sur le fardeau des maladies cardiovasculaires et cardiométaboliques chez les survivants de la COVID-19, ainsi que les effets indirects de la pandémie sur la santé cardiovasculaire des personnes n’ayant jamais été infectées par le SRAS-CoV-2. Nous traitons aussi des effets de la pandémie sur les systèmes de soins de santé, en particulier des problèmes causés (ou exacerbés) par le report des soins ou le renoncement aux soins durant la pandémie. Nous passons en revue les conséquences : 1) du report ou du retard des soins dans les cas urgents; 2) de la transition vers la virtualisation des soins externes; 3) des pénuries de médicaments et d’appareils médicaux; ainsi que des difficultés d’accès : 4) aux tests diagnostiques, 5) aux services de réadaptation cardiaque et 6) aux soins à domicile. Nous présentons par ailleurs les conséquences globales de la pandémie de COVID-19 sur la santé cardiovasculaire et sur les praticiens en santé cardiovasculaire au moment où commence une nouvelle phase de la pandémie.

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Figures

Figure 1
Figure 1
Effect of delayed or foregone health care during the COVID-19 pandemic, as reported by American adults in September 2020. ADL, activity of daily living. Modified from Gonzalez et al. with permission from Urban Institute.
Figure 2
Figure 2
Effects of the COVID-19 pandemic on cardiovascular (CV) morbidity and mortality. Modified from Lau and McAlister with permission from Elsevier.
Figure 3
Figure 3
Canadian long-term care (LTC) resident COVID-19 deaths vs COVID-19 community deaths to August 15, 2021. Reproduced from the Canadian Institute for Health Information with permission.
Figure 4
Figure 4
Changes in transfers of long-term care residents to hospital during the pandemic, according to reason for transfer, March 2020 to June 2021. Reproduced from the Canadian Institute for Health Information with permission.
See this image and copyright information in PMC

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