COVID-19 impacts cardiac care in the United Kingdom

By Lakshmi Supriya, PhD.Dec 4 2020

Postponing non-urgent cardiac care and surgeries because of COVID-19 will likely increase demand for cardiac care along with increased costs. In the future, there will be a need to find ways to provide the same level of care at reduced costs.

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The rapid spread of the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has stressed medical systems worldwide. In the United Kingdom (UK), all non-urgent elective surgeries were abruptly stopped in April 2020. An already stressed National Health Service (NHS) has been further under pressure because of the pandemic.

Data show that the NHS is performing poorly compared to other European countries in terms of beds and doctors available. This has led to a decrease in providing healthcare for non-COVID-19 patients and prioritizing COVID-19 patients has severely impacted care for people with other illnesses.

As the NHS is beginning to restart services for non-COVID-19 patients, there is a huge backlog of patients, about 4 million, waiting for routine procedures. This may likely increase to about 10 million by the end of 2020, dramatically increasing waiting times.

Addressing this challenge will become even more difficult with healthcare services operating with reduced capacity to comply with COVID-19 prevention measures.

Effect of COVID-19 on cardiac care

In an editorial in the Journal of Cardiac Surgery, researchers from Imperial College London, University of Oxford, and Royal Blackburn Hospital report what the UK government’s response to the pandemic means for future healthcare in the UK.

The UK economy contracted by 20% in Q2 because of the nationwide lockdown imposed in March 2020. The government provided a huge public stimulus to help the economy recover. This increased public spending and reduced tax revenue, lead to the highest debt to GDP ratio in the last 50 years.

The short-term impact of the pandemic on NHS could be an increase in spending, with the public becoming more conscious of a well-functioning NHS and improved healthcare spending.

However, the poor position of the UK government’s finance will likely cause NHS spending to grow at a slow rate. For cardiac surgery, this means spending has to increase if there is no improvement in cost efficiency to maintain the same level of service.

To reduce the burden on the health service and to prevent infections in patients requiring cardiac care, many non-urgent surgeries have been postponed. Patients with coronary diseases also tend to have other co-morbidities like hypertension and obesity, which are known to lead to severe COVID-19 and poorer outcomes.

The risk of hospital infections has also led to changes in surgical practices. Standard procedures like opening the thorax in coronary artery bypass graft are not considered high risk and will impact the types of interventions offered by doctors.

In addition, the number of patients with strokes and heart conditions that are coming to hospitals has decreased considerably. When they do go to the hospital, the condition may have worsened, forcing physicians to perform elective surgeries as emergency operations, increasing risk. All of this will increase the cost of cardiac care.

The long-term impact of COVID-19

Reports on SARS-CoV-2 cases suggest although the primary target of the virus is the respiratory system, it can also lead to inflammation of the heart, heart attack, or heart failure. Since the virus weakens the immune system, it may also make surgery patients vulnerable to bacterial infection, slowing, or threatening recovery.

In the long term, a reduced number of cardiac surgeries being performed will impact the development of the field in the UK. Medical trainees may see fewer operations, reducing their progress. Examinations and teaching may be canceled.

Cardiac surgeons could be redeployed to intensive care units caring for COVID-19 patients. Strict guidelines on isolation after COVID-19 symptoms or close contact with patients will reduce the number of medical staff available, increasing workload on remaining members.

Although virtual consultations are suggested for all except for those needing urgent care, it is yet unknown how effective these are, especially since doctors will not be able to examine patients and take observations like blood pressure and heart rate.

The combination of postponing elective cardiovascular surgeries, reduced acute care and long-term cardiac damage directly resulting from COVID-19 will likely cause increased demand for cardiac care, particularly from patients presenting with more severe symptoms,”

Increased demand for cardiac care and low supply of care providers means it will likely take a long time for cardiology care to recover from the effects of the pandemic. Thus, there will be a need to find ways to provide superior cardiac care at a reduced cost.