COVID-19 has affected people of all age groups directly or indirectly, but those who are having comorbidities have found to be at receiving end. Heart patients had tough time during lockdown as they couldn’t seek consultation due to accessibility issue. Hospitals conducted only a handful of surgery during that time. Fear factor was another reason they couldn’t seek medical advice. Routine check up was also got delayed due to genuine reasons that they might catch infection at hospitals. It was double whammy for providers as they couldn’t call such patients at hospitals due to corona and at that same time couldn’t leave them unattended. Things have improved now, and people have started rushing to hospitals for surgery and routine checkup.
Elets Technomedia recently hosted two panels of experts on World Heart Day to know their viewpoints on cardiovascular management vis a vis covid-19.
While participating during discussion, Dr T S Kler, Chairman, PSRI Heart Institute, said: “Covid and heart diseases have two way relations. If patients have already suffering with cardiac diseases, they will be prone to infection. Chances of mortality are high in that case. Every heart patient is not at same risk during covid. If a patient had heart failure or he or she is on device like CRT, they are at high risk. But if a patient had angioplasty, his heart functions normal, BP is controlled, he is not at high risk. All high risk group people are vulnerable. If a patient is young (25-30),he may develop cardiac manifestation. Covid increases coagulablity of the blood—chances of block formation. In heart attack, blockages have to be cleared from the culprit artery. There is a pseudo heart attack where people feel chest pain due to virus led infection on heart muscle.”
Dr Balbir Singh, Chairman – Cardiac Sciences, Max Healthcare, gave an insight on how patients faced issues and lost life during lockdown. “We have been going through with tough time. During initial phase of lockdown many patients lost lives due to lack of medicine or timely healthcare facility. Patients from remote areas couldn’t reach at any healthcare facility. Due to several protocols, they couldn’t reach us. It was measurable time for heart patients during lockdown. There was so much fear among people that they were apprehensive to reach hospitals even if they had chest pain like symptoms. Good thing is that patients are less fearful and started visiting hospital. We tell patients to visit hospital only when they face issues. For aged person having co-morbidity, this is very difficult time,” Singh said.
Highlighting the fact how the disease was a challenge for medical fraternity, OP Yadava, CEO, National Heart Institute, said: “It was a double whammy. Both patients and medical fraternity were not prepared to take the pandemic head on initially. Mortality has now come down. Most important thing which has happened that change in our concept of pathogenesis of the disease. Today we know that it is thrombotic process and introduction of anticoagulant has changed the scene. Building confidence among staff was very important. Training of the staff was another important area. Giving PPE was not a solution but how to use it properly. We created covid and non covid area and tried to concentrate on patients in these two areas. Acute and chronic care were brought together at some extent.”
Dr. Ganeshakrishnan Iyer, Lead Consultant – Cardiothoracic and Vascular Surgery – CTVS Surgery, Aster CMI Hospital, held the opinion that frontline workers were more at risk. “Initially patients were not visiting hospitals due to fear of catching infection which lead to many death. But things have changed now and patients have decided to get themselves treated despite covid. Healthcare professionals didn’t know how to get themselves protected as they had less idea about the disease. There was a fear among doctors initially on operating covid positive patients. Operating with PPE is very difficult. We had very few patients turning up for surgery during lockdown. Currently, we are admitting patients and test them for covid-19.If they are negative, we operate them with moderate precautions like wearing N95 masks and all. Risk of healthcare workers catching infection is much more today,” Iyer said.
“Management of COVID-19 is little different. It is a new disease for all of us. Very few doctors are available for COVID-19 treatment vis a vis cardiac diseases. It is not a surgical issue but it aggravates to this level when one avoids to seek medical advice. Patients’ family must be explained the risk of surgery,” Dr K M Cherian, Cardiac Surgeon, Frontier Lifeline Hospital said.
Participating in another panel Dr Muthu Jothi, Senior Paediatric Cardiothoracic Surgeon, Indraprastha Apollo Hospitals, said: “Pediatric cardiac surgery has also suffered like any other specialty due to ongoing pandemic. In last six months, many of kids have lost lives as they couldn’t reach hospital on time. There are many reasons including unable to travel and financial issue. We don’t have any regular surgery happening in pediatric, except emergency. There are diseases that needs immediate attention but people fear to travel or visit hospitals due to fear of infection. Emergency care can’t wait till things get over.”
Dr Ravi Prakash, Senior Consultant, Vimhans Nayati Super Specialty Hospital said patients with cardiac issues were predisposed for covid-19. He said: “We are dealing with a double whammy—Cardiovascular disease along with ongoing COVID-19 which is a medical and social crisis. We are not only dealing with disease but something which is associated with fear and so many other issues. Our healthcare system is already stressed. Patients who had already cardiovascular diseases are predisposed to corona infection. Moreover, patients are apprehensive to visit hospitals, seeking usual cardiac care because of the fear of catching infection. Mortality rate due to corona infection among normal patients is low. But death rate due to cardiovascular disease is much more in comparison to covid-19. People should not ignore any non covid issue. People should not dither on health issues.”
Dr Girish Navasundi, Senior Cardiologist, Apollo Hospitals, Bengaluru pinpoints shortcomings of our healthcare system to take on such challenge. “Present crisis is most overwhelming and unexpected magnitude of health challenge the humanity has ever experienced. Covid-19 has brought shortcoming of our healthcare system, both private and governments to the fore. We have shortcomings at leadership level—industry, hospital and govt level. When we had crisis of this magnitude, we were not prepared or least prepared. We must lookit as a challenge not as care. Cardiac disease is a number one killer of the world. Corona is for short duration but cardiac issues will always be there. At Apollo, we put in lots of investment to meet demands during covid times. We require lots of courage from healthcare workers and community to defeat the pandemic,” Navasundi said.
Dr Rajeev Rajput, Senior Cardiologist, Indraprastha Apollo Hospitals believes fear factor is genuine and justified. He said: “There has been a reasonable effort on part of all stakeholders— advertisement on TV, hospitals, health industry that covid-19 can be prevented by social distancing, wearing mask, and using hand sanitizer on regular interval. We all have tried our best but couldn’t provide care as expected. Most of the cardiac patients have faced huge problems. No hospital could provide proper care due to coronaled issues at level of admission or financial front. Same hospital could have provided better care in normal situation. Patients were also fearful to visit hospitals to consult experts. Health facilities were also not prepared to take on such unexpected challenge.”
Dr Rahul R Gupta, Consultant Cardiologist, Apollo Hospitals, Navi Mumbai, said: “COVId-19 is double-edged sword. Corona itself can increase instances of heart disease. Because of fear of the pandemic& stress to visit hospital to get themselves treated, people are dying at home or at times in hospital when they reach at last stages. Many a people afraid to visit hospital due to fear of infection and unknowing put themselves at risk of heart related complications. So many patients are dying as they visit hospital at last stages where we don’t have much scope in terms of positive outcome. Corona itself has multiple mechanisms where it can precipitate heart illnesses. Many of heart patients have not maintained disciplined life style due to lockdown— no exercise, eating unhealthy food. Their diabetes and BP have uncontrolled, putting them at risk.”