Listen to Your Body and Heart. Avoiding Doctor Visits Won't Stop Potential Disease.

MHE Publication, MHE August 2021, Volume 31, Issue 8

Many people ignored heart disease signs and symptoms during the COVID-19 pandemic — sometimes with grave consequences.

Throughout the COVID-19 pandemic, people have been understandably hesitant to be in public places, including doctors’ offices. Results of a study done by the CDC in late 2020 showed that 41% of adults were avoiding or postponing their regular medical appointments and annual screenings because they feared they might contract COVID-19. That hesitancy has resulted in delayed or forsaken care of all types, with delays in cardiac care among the most consequential.

“Over the last 15 months, people have feared COVID-19 more than they have feared the signs of heart disease, but it is absolutely critical that they notice and seek treatment for those symptoms,” says Philip B. Adamson, M.D., M.Sc., FACC, divisional vice president, chief medical officer of heart failure for Abbott. “Millions of people are impacted by heart disease and don’t even realize that an earlier diagnosis can allow for more effective treatment options. Once a patient with heart disease reaches a certain stage, their condition begins to rapidly deteriorate.”

Consider the circumstances of Chief Petty Officer Ramon Rinkin, 41, a yeoman in the Navy with a family history of heart disease. When Rinkin, a husband and father of three, began experiencing symptoms of indigestion and heartburn during the pandemic, he brushed them aside.

However, as he was getting ready for work one day, he went into cardiac arrest and collapsed in the bathroom. His wife, Melania, began CPR and called 911. Rinkin went into cardiopulmonary arrest at home and again in the ambulance before arriving at Saint Francis Hospital in Bartlett, Tennessee. He then went into cardiogenic shock and coded once more before interventional cardiologist Raj Dave, M.D., inserted an Impella heart pump. Two weeks later, he walked out of the hospital with his healthy, native heart.

Instances such as this were not uncommon during the pandemic because many people, afraid to go to a doctor or hospital, ignored warning signs of heart issues.

Trevor Huber, D.O., a family physician and president and founder of Modera Clinic in Little Elm, Texas, saw this as a huge problem in the past year, especially during the height of the pandemic.

“We saw a drastic increase in patients (who) were experiencing heart disease and heart attacks and not getting care as quickly as they typically would have because of the fear of contracting COVID-19,” he says. “We found this out months later when they would tell us the symptoms and we realized they had had heart attacks while in quarantine and were too afraid to visit our office.” In fact, one of his patients died on Father’s Day after ignoring warning signs.

“His wife told us (afterward) that he had been experiencing heart attack symptoms for two weeks but put off coming in to visit because of COVID-19 fears,” Huber says. “We had another new patient who we set up for a telemedicine visit because he thought he had COVID-19. Once we began the televisit, we realized he was actually experiencing a heart attack. He was very reluctant to come in even after we discovered this, but, thankfully, we were able to convince him of the urgency and were able to transport him to a hospital to get his blockages opened.”

Oluseyi Princewill, M.D., M.P.H., a cardiologist at MedStar Health in Olney, Maryland, saw a significant decline in office visits for chronic disease management and acute symptoms such as chest pain since March 2020. “We also know that many people heeded the warnings to stay home and not further strain the healthcare system,” she says. “In retrospect, that message should have been coupled with public service announcements about the importance of being seen by a healthcare provider for symptoms concerning heart attacks or strokes.”

Christopher Price, M.D., is a retired cardiologist in the Seattle area who has a health advisory business named Call Doctor Chris. He notes that the ramification of patients not coming in sooner rather than later with their cardiac symptoms is that they are likely to be more ill upon presentation and to potentially stay longer in the hospital. They also might have more complications from their event.

If a patient with atrial fibrillation is seen in the first 48 hours, they could be cardioverted (when the heart is shocked back into normal rhythm) and discharged the same day. If they wait, their risk of stroke likely will be too high to convert their abnormal rhythm safely.

“They would then need to be treated with blood thinners for a month prior to the shocking,” Price says. “Alternatively, the cardiologist may offer (transesophageal echocardiography)-guided cardioversion, but this requires sedation and other risks and expenses.”

“Also,” Price continues, “by waiting longer than 48 hours in this rhythm, the patient risks the possibility of developing heart failure from this uncontrolled rhythm.”

Continued reluctance

There are many reasons to believe a surge in patients with heart and lung disease is coming. Adamson says he has seen reports that more than one-third of American adults skipped or delayed medical care due to the pandemic. But with vaccination and the resumption of normal activities, most physicians are seeing fewer patients delay care when they have major issues. “However, now we are having difficulty getting patients back in for preventive care and routine visits,” Huber says. “Patients have become accustomed to the convenience of telehealth visits, but there are still visits and tests that require in-person interaction. We’re seeing a continued reluctance among some patients to come back in for those visits.”

Another consequence of not seeing a physician is that patients don’t get to discuss or ask questions about heart disease.

“These moments that doctors spend with their patients discussing risk factors and symptoms can have just as much impact as the tests themselves,” Price says.

Elevated blood pressure, blood sugar and cholesterol levels are cardiovascular risk factors. Huber says that without wellness visits it was difficult to help patients stay on top of those risk factors.

“This really tied our hands, (and we were unable to treat) problems early on before they led to heart disease,” he says. “We have seen a nationwide increase in mortality, including cardiovascular disease, since the pandemic began.”

In response, he says, his practice has been more aggressive in performing screening tests and obtaining electrocardiograms.: “We are doing more testing now than ever to help our patients get a clear picture of their heart health.”

Princewill hopes to see more patients following up in the clinic for their routine visits. Since spring, she already has seen a promising uptick.

“We’re optimistic that number will continue to increase as more individuals are fully vaccinated and case numbers continue to decline,” she says. “I urge everyone to follow up with their healthcare providers as soon as possible if they haven’t already been seen or scheduled an appointment. It is also important to control our risk factors. The more we eat right, sleep better, exercise and take care of our mental and heart health, the more likely we are to reduce our risk of severe illness.”

Neil Moat, M.D., a cardiologist and chief medical officer of Abbott’s structural heart business (treatments for valvular heart disease and other conditions) says now that the pandemic may be easing up and people are looking to return to some sense of normalcy, everyone should focus on getting their health — and perhaps especially their heart health — back on track.

“Before the COVID-19 pandemic, heart disease was the leading cause of death worldwide, and that hasn’t changed,” he says. “With individuals deprioritizing medical appointments and everything that’s happened over the past year taking a toll on physical and mental wellness, there’s a risk that undiagnosed and undertreated heart conditions will now start coming to the surface.”

He urges patients to reflect on any changes related to their physical or mental wellness they’ve noticed in the past year, as shifts in things such as stamina, mood and pain levels could be signs of potential heart and cardiovascular issues.

“Discussing any observations and questions with your doctor can help them map out a plan for you, whether that includes exams, lab work or treatment,” Moat says. “As the (population) continues to age, heart disease will remain top of mind for years to come, and its prevalence shows no sign of declining.”

Keith Loria is a freelance writer in the Washington, D.C., area.