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We must stem the rising tide of heart and circulatory diseases

The impact of the Covid-19 pandemic on heart patients so far is just the tip of the iceberg

By Charmaine Griffiths  

This article was produced in association with British Heart Foundation

Throughout the pandemic we’ve seen the very best of British healthcare and of British science. But for many of us, it has also been a time of uncertainty and tragedy. The estimated 7.6 million people living with heart and circulatory diseases in the UK, as with other long-term conditions, have been hit particularly hard. From difficulties accessing primary care to facing delays in potentially life saving heart operations, the impact felt today is just the tip of the iceberg – it will take years to see the true toll of the pandemic on cardiovascular care.

Deaths from heart and circulatory diseases have increased

Heart and circulatory diseases cause around a quarter of all UK deaths, killing one person roughly every three minutes. During the pandemic, deaths from these conditions have sadly increased further, with over 5,800 excess deaths from heart and circulatory diseases in England alone by the end of 2020.

In part, these excess deaths were directly due to the Covid-19 virus. Research suggests that people with cardiovascular diseases are almost 4 times more likely to be at risk of severe outcomes and almost 3 times more likely to be at risk of death from Covid-19.

But this doesn’t explain all the additional deaths from heart or circulatory diseases seen over the last year – it is highly likely that widespread disruption to the health system and ongoing delays to care have contributed.

Routine cardiac care has been significantly disrupted

Despite the unwavering efforts of the NHS, we know that heart patients have faced delays at every stage of their care.

In the early stages of the pandemic, the health service swiftly and heroically adapted to cope with increased demand and to protect patients from the spread of Covid-19. This necessarily included redeploying staff away from cardiovascular services to supporting frontline Covid-19 care.

Difficult decisions like these were necessary, even though they were bound to significantly impact capacity for cardiac diagnostics and treatments including heart surgery throughout the pandemic. Despite widespread exhaustion, NHS staff have already moved directly onto tackling the backlog of care to minimise any long-term implications for the lives of people with heart and circulatory diseases, but they will need more support to do this.

Missed diagnoses will have an impact for years to come

During the pandemic there was a steep and sustained drop in cardiac referrals and diagnoses. Amongst other things, this has meant that millions of people are likely to have gone months living with undiagnosed or untreated cardiovascular risk factors like high blood pressure or diabetes.

In fact, the IPPR estimates there were 470,000 fewer new prescriptions for preventative cardiovascular drugs such as heart failure medicines, antihypertensives, statins, and anticoagulants last year.

Significant delays at the start of the heart disease pathway can lead to delayed diagnosis, treatment and ultimately poorer outcomes for patients.

There is a growing backlog of people waiting for treatment

We know that a significant number of planned procedures have been cancelled or delayed during the pandemic, with around 100,000 fewer heart operations performed in 2020 compared to 2019 in England. This includes life-saving surgery like coronary artery bypass, as well as procedures like fitting stents to open blocked arteries.

Reduced capacity to deliver these procedures has led to increased waiting times for patients. We’ve seen a 150-fold increase in people waiting over a year for heart procedures in England – at the end of February 2021, 5085 people had been waiting over a year, compared to just 28 at the end of February 2020. These long waits for heart treatments are unlikely to have been seen since the 1990s.

We are all concerned that the longer patients wait for treatment, the higher the chance their symptoms will worsen, they’ll develop long-term complications or will need emergency care.

Number of patients waiting for heart procedures for over a year

The unseen impact of the pandemic is vast

This is the impact we know that the pandemic is having on heart patients so far. But we are afraid there is much more yet to be seen.

First, we may be facing a ticking cardiovascular time bomb due to the drop in the detection and management of risk factors. If conditions like hypertension are left untreated, more people could potentially experience cardiovascular events like heart attack or stroke, adding significant pressure to an already strained NHS. Linked to this, some ethnic minority groups are already at higher risk of developing risk factors for heart disease and we know that the pandemic has exacerbated these pre-existing health inequalities.

Despite the unwavering efforts of the NHS, we know that heart patients have faced delays at every stage of their care, on a scale never seen before

Secondly, the pandemic has taken a psychological toll on many of us. People living with heart and circulatory conditions were already at increased risk of poor mental health, and uncertainty about accessing treatment and tough decisions around shielding have likely exacerbated this. After a year of working under extreme conditions, we also know that healthcare professionals are exhausted. Concerns have been raised about the level of fatigue and stress among NHS staff and how that will impact workforce retention in the short- and medium-term. We recognise there are no simple solutions, but for a system that was facing significant shortages before the pandemic, this could further disrupt cardiac care for years to come.

Finally, without tailored support from Government for life saving medical research, we jeopardise future innovations in preventing, diagnosing and treating heart and circulatory conditions. The BHF had to halve its 2020/21 budget for new research to just £50m due to a fall in charitable income caused by the pandemic. As the largest funder of non-commercial cardiovascular research in the UK, this decrease in research spend risks undoing some of the phenomenal progress made to reduce the number of deaths from heart and circulatory diseases to date.

We can turn the tide on heart and circulatory diseases

The NHS and its staff have moved mountains this past year, saving countless lives. Sadly, heart and circulatory diseases did not stop for the pandemic, and we’ve been proud to play our part in supporting patients during this time. This includes expanding our Heart Helpline and partnering with the NHS and others to encourage people to call 999 when they need emergency care.

Collectively, as Covid-19 cases now begin to recede, we face a tremendous challenge in reaching every person whose diagnosis or treatment has been impacted. To ensure it has the required resources to urgently clear this growing backlog of cardiac care and build back routine services better, Government must provide a clear recovery plan for the NHS, including a realistic and adequate workforce strategy, coupled with the necessary short and long-term investment now.

To minimise the potential longer-term effects of the pandemic, Government must also adequately invest in public health to help to create a healthier, more resilient nation, and protect life saving charity-funded medical research. Charities play a vital role in the UK’s world-leading research ecosystem and providing a financial life raft during this vulnerable period in which charities like the BHF have been hard hit will allow us to continue funding research that leads to breakthroughs for people with heart and circulatory diseases.

By acting now, and enabling NHS England to deliver its ambitions in the Long Term Plan to reduce heart attacks and strokes, Government can defuse this potential cardiovascular timebomb.

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