This past spring, the American College of Cardiology (ACC) reported that emergency rooms across the United States were seeing a large drop in heart attack admissions. UAB Medicine also saw a decrease in cardiovascular event cases, due to patients’ fear of COVID-19. UAB Medicine responded by expanding its telehealth services and creating policies to protect patients and staff, so that it could safely provide cardiovascular care to those who need it.
Surveys show that almost 60% of Americans are putting off hospital visits due to the COVID-19 pandemic. Doctors and hospitals say this situation is manageable for many health conditions. But for major medical emergencies such as stroke or heart attack, providers know that patients risk serious consequences if they wait for symptoms to get worse before seeking medical attention.
“In normal situations with my practice, I would see many people arriving with acute issues such as small or large heart attacks, or blockages that required the repair of heart valves,” Dr. Ahmed says. “When COVID came along, all of that just stopped. There was this disturbing period when no patients came in for such conditions. That was for two reasons. First, hospitals were kind of on standby for certain cardiovascular procedures, because safety policies were still being developed in the early weeks of the pandemic. Providers were preparing to be overwhelmed by a first wave of COVID patients. Second, patients were afraid to enter ERs. Of course we knew that people were still experiencing cardiovascular events.”
Other factors, such as less workplace stress due to working from home, may have contributed to the drop in cardiovascular cases in the first weeks of the stay-at-home orders. So the exact cause of this trend is unclear. However, providers do know that significant numbers of patients are delaying care for their early cardiac symptoms. This is called “late presentation”. It’s an alarming trend, considering that heart disease is the No. 1 killer of Americans each year and responsible for one in four deaths.
The Danger of Delays
Dr. Ahmed says this trend suggests that patients were willing to gamble with their health, hoping to ride out minor cardiovascular symptoms rather than risk exposure to COVID-19 during a hospital visit.
“If you have heart attack symptoms, waiting see how they turn out is a dangerous choice,” Dr. Ahmed says. “Essentially, you’re delaying care for fear of suffering a theoretical condition, the virus, because you may or may not catch COVID. But the condition you are gambling with is definitely not theoretical. It is significantly more likely to cause death or greatly reduce your quality of life. Some heart attacks can be so severe that the heart wall will burst. You rarely see that, because most people go to the ER when symptoms get severe. But in the last few months, I’ve seen cases this extreme. I can’t emphasize it enough – there is zero advantage to riding out the symptoms of a heart attack.”
Dr. Ahmed says putting off care is risky because there’s a narrow window of opportunity for successfully treating major cardiovascular events.
“If you have a heart attack right this moment, for example, our care team has a ‘golden window’ period in which to repair arteries in order to prevent damage to the heart muscle,” Dr. Ahmed says. “The longer you stay outside of that period, the more you risk greater damage to heart tissue. Some muscle tissue has probably died, so it can’t usefully be repaired after that time. That leads to heart failure, so now you’re walking around with limited pumping function. At some point it will get so bad that you can’t breathe well, then you can’t lie flat on your bed at night, and then you’re in trouble.”
Dr. Ahmed says UAB Medicine performs a high volume of transcatheter aortic valve replacement (TAVR) procedures. TAVR is a minimally invasive procedure that eliminates the need for open-heart surgery and offers a shorter recovery time with less risk to the patient. Unfortunately, many patients who could be treated with TAVR delayed seeking care.
“Because of COVID, we had a waiting list for TAVR, but we made sure that those in the most need could get the procedure,” Dr. Ahmed says. “Even so, we had several patients with severe aortic valve disease who told us they wanted to wait. Some of those patients died while waiting. Put simply, a cardiovascular event is among the highest order of medical conditions that cannot wait.”
Reversing the Trend
In response to the pandemic, UAB Medicine established policies and processes to ensure the greatest possible safety for patients and staff and encourage people not to delay their care. Patient safety has always been a top priority at UAB Medicine, but care teams are doing even more now to prevent the spread of COVID-19.
“What I would like patients to know is that, thanks to tremendously successful efforts by committees and staff whose sole focus is COVID safety and prevention, our hospital today is very different from the hospital it was just four or five months ago,” Dr. Ahmed says. “We are safely performing vital surgeries and procedures, with minimal risk of contracting COVID.”
The rapid expansion of UAB eMedicine telehealth services also contributed to the success in caring for cardiovascular patients during the pandemic. UAB eMedicine uses video technology to enable real-time communication between patients and doctors or other providers through a computer, mobile device, or the telephone.
“The eMedicine expansion allowed access for hundreds of patients we otherwise might never have seen,” Dr. Ahmed says. “What I find amazing is that you can actually detect from the interview when someone needs to come to the hospital. UAB’s expansion and marketing of telehealth has been critical, and it’s been the primary point of access for people who were reluctant to come in. Along with providing care, telehealth is also educating patients that it is indeed safe to undergo crucial procedures. In my mind, there is no doubt that this technology saved a significant number of lives.”
Click here to learn more about cardiovascular care at UAB Medicine, COVID-19 safety policies, and clinic visits using UAB eMedicine telehealth services.