dr Kohli on COVID – Docwire News

The peak of the COVID-19 pandemic affected all areas of healthcare, especially cardiology. In this interview DocWire News Medical Director Payal Kohli, MD, FACC spoke about which cardiology services were hardest hit, the long-term impact of COVID on the heart, and whether or not healthcare is prepared for a future pandemic.

DocWire News: How has the COVID-19 pandemic affected cardiology?

dr Cabbage: It’s unbelievable what we’ve experienced in the last few years. And I think the effects of what happened will be felt for decades to come. So we know that there are both direct and indirect impacts that have occurred as a result of COVID-19. So the direct impact is the people who have had COVID and have recovered from it. And some of them had cardiovascular complications during their illness, and some may have complications like Long COVID, because we know this virus doesn’t just affect the heart muscle. It can also act on the blood vessels. So it really is a systemic virus, not just a respiratory virus. And then of course there are the indirect effects, some of which I think we can’t even begin to appreciate or grasp. But we do know that there has been tremendous disruption to healthcare and people’s self-sufficiency.

Which cardiology services were hardest hit at the height of the pandemic?

In recent years there has been a marked increase in mental health problems and substance abuse, obesity and deconditioning. And then, of course, many people were afraid to go to the doctor to have their chronic diseases treated. So the American Heart Association and others have actually released data that we are really looking at a new curve of the pandemic in the coming years. And that’s what I like to call the prevention curve, because preventive healthcare really took a backseat. In fact, some people in the midst of their heart attacks didn’t go to the hospital and seek help. A small heart attack turned into a big one with many, many complications.

It’s so interesting that you asked this question because it was about the services themselves. And then there was the service workforce, because we know vendor burnout was at an all-time high. And we call it the great resignation, which also applies to medicine. We have lost many medical professionals to the pandemic. So there is actually data from the British Medical Journal looking at the first month or so after lockdown. And what we’re seeing is the number of cardiology and ward and CCU admissions is down 53%, which is incredible when you think about it. They’ve basically reduced the number of patients going to the hospital or intensive care unit by 50%, and the number of heart attack diagnoses has actually gone down by 40%. Well, that doesn’t mean that the number of heart attacks has gone down, it just means that we haven’t done a very good job of diagnosing these heart attacks, especially early detection.

We also know that during the height of the lockdown, there was a 93% drop in in-person visits. Of course, some of this was offset by virtual visits or telemedicine, but we don’t think the offset or impact of the virtual visits made up for the missing portions of care that we saw face-to-face during the visit. So this really was during the height of the lockdown. But even after we shifted our lives back to the endemic phase and settled back to normal, we know there were a number of things that impacted patient care. For example bottlenecks in the supply chain. And we’re talking about the shortage of substances like contrast media used in the cath lab in the midst of an acute ST elevation myocardial infarction or a non-ST elevation myocardial infarction. It’s a must-have type of medication.

It’s not something you can live without. And there were bottlenecks and some cath labs had to go on diversion and stuff because they didn’t have enough contrast to do their procedures. Similarly, with outpatient medication, I have a number of patients who have not been able to get their blood pressure medication on time. They couldn’t get their CPAP machine because there was a back order for CPAP. The domino effect caused by the disruption in our lives will, I believe, really continue to manifest itself over the next few years and may still be an integral part of our daily clinical practice.

Do we have any idea of ​​the long-term effects of COVID on the heart?

We’re just starting to learn. I think we’ve done a tremendous amount of research over the last few years to really understand what the effects are. The virus is changing a bit. So we know that the original Wuhan variant may have had different effects than the Delta variant, which was very severe, compared to the current Omicron variant, which appears to be milder. We know that the ACE2 receptor, the receptor that the virus uses to enter cells, is present on blood vessels. It is present on myocardial tissue, i.e. on the heart muscle. So that certainly increases the risk. But I think even after the initial infection, which is relatively mild for many people now as part of being vaccinated and boosted and taking Omicron, we see that up to one in three people can have signs or symptoms of a long COVID. which may include a cardiac manifestation.

So in my practice I see several patients coming in for workup of long COVID every week and we can see conditions like dysautonomia, exercise intolerance, persistent fatigue and some of these can even come on months and months after the original index disease suggesting that that it is not just a post-viral syndrome. Now, I’m really excited about the advent of the bivalent vaccines because I believe vaccination is key to minimizing the impact of some of these long-term complications, particularly the long-term cardiac complications, which some of us are really challenging how to treat at all because it’s not there are many great treatment options.

Do you think the healthcare system is prepared for a future pandemic?

I would love to say we are, but unfortunately I have a feeling we are not. And forget about future pandemics. We just had a little mini test on the recent monkeypox outbreak that we had in our community to see how we might respond to future infectious diseases like this. And I hate to say it, but I think we failed the test as a community. Now, as individual vendors, I would say that we are absolutely a lot more prepared than we were before we went through the COVID-19 pandemic. I also think that the patients themselves are much more educated, they are much better informed, they ask the right questions and many of them are attuned to their preventative health. So I think we’ve come a long way as individuals. But I think as a community, as a whole, as a country, even as an international community, we really need to do better to increase universal access and try to really figure out how we can change our national responses to get a head start the virus, and actually being proactive rather than tracking what the virus is doing and reacting to what’s going on.

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