By Dr. M.N. Ravi, Senior Heart Specialist and Director, Narayana Multispeciality Hospital, Mysuru

Use heart to beat heart disease is the theme for World Heart Day 2020, observed on Sept. 29. This prods the health care professional to help people make positive changes to safeguard their health and ‘act in ways’ that support the most vulnerable in society — those with known heart disease that may put them at greater risk in the time of COVID 19. This is also the clarion call for heart patients during the COVID 19 pandemic. 

Hospitals worldwide including India received and treated less than 50% of usual numbers, particularly those needing emergency heart care in the last six months. A leading cardiologist at the national capital stated that while patients seeking emergency services for heart conditions reduced, there was a marked increase in deaths from cardiac arrest at home. This could be due to delay or postponement in patients seeking urgent  medical attention.

Patients delayed coming to the hospital due to Corona scare and ended up with problems like heart failure or even death. This would also be true in patients needing dialysis, treatment for cancer or strokes. Avoiding hospital visit and denying themselves urgent medical attention for fear of COVID 19, is it justified? 

Medical organisations across the world like the ICMR have issued guidelines for managing heart patients during the pandemic. Establishing separate facility for managing non-COVID disease with negligible risk of COVID 19 transmission is a reality in hospitals of repute.

Different publications from across the globe have noted the increased risks associated with inadequately treated hypertension, diabetes, existing heart disease, heart attacks, heart failure and enhanced morbidity and mortality of such patients infected with COVID-19. Other high risk groups include elderly and frail people, also pregnant women with concomitant  heart disease.

Patient above 60 years of age, hypertension, diabetes, obesity with COVID-19 infection have up to 5 times increased risk of dying from it. Patients with the above mentioned risk factors should not hesitate to seek medical help to keep their medical condition under control.

COVID-19 is a spectrum disease, ranging from being asymptomatic to causing critical illness. The virus also affects previously healthy hearts and also young individuals and in multiple ways. COVID-19 manifestation in the heart includes myocarditis (direct injury) causing heart failure or increasing clotting in the heart vessels causing heart attacks. Clots in the head and neck vessels could cause brain strokes. Such patients need emergency treatment and ICU care and should reach out to hospitals. 

COVID-19 affects and exacerbates conditions in patients with heart disease and these patients are susceptible to more severe form of COVID-19. “It’s like one big stress test for the heart,” said Dr. Ridker, Professor of Medicine at Brigham and Women’s Hospital, USA. This stress is compounded if the lungs are infected and incapable of adequate gas exchange. This further diminishes oxygen supply to the heart. Case fatality rate for COVID-19 in patients with Cardiovascular disease including heart failure is reported to be as high as 10.5% compared to fatality rate of 2.3% in                          general population.

It is known that most viruses often affect those with underlying illnesses more critically than those in better health. Any infection in the body, like in the skin, bone or muscle or diseased kidney, liver or heart with infection can release inflammatory substances. When these molecules reach the possible site of nidus in the wall of the blood vessel, already a site of atheromatous plaque, the molecules like the cytokines can boost the inflammatory response and trigger a heart attack. All sources of infection and inflammation need early attention to prevent catastrophes. 

73% of COVID-19 deaths in India are linked to underlying health issues such as diabetes, hypertension, cardiovascular and respiratory diseases. Reports from Centre for Disease Control and Prevention and other health agencies showed that the risk of a fatal outcome from COVID-19 is upto 50% higher in patients with diabetes. Awareness which is key in other times is everything during the pandemic. 

A key pillar of COVID-19 pandemic management is to create awareness to seek medical care in patients with existing heart disease, heart attacks, diabetes, hypertension, lung disease, kidney disease, cancer, infections and immunocompromised conditions. 

Affordable and uninterrupted health services are a must. These conditions and COVID-19 infection cut across all sectors and income levels.

Meeting the challenges of creating awareness to seek immediate medical help and treating those most at risk from COVID-19 would be critical to containing damage and enhancing care in the long term. The health care fraternity should come together to spread the message before, during and after the World Heart Day.