COVID-19: Nearly 100,000 More Deaths from Cardiovascular Disease Since the Start of the Pandemic in England

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Since the start of the COVID-19 pandemic, England has experienced a devastating increase in deaths related to cardiovascular disease.

According to a recent analysis published by the Office for Health Improvement and Disparities (OHID), there have been approximately 100,000 more deaths involving cardiovascular conditions than expected during this period. This alarming statistic highlights a pressing crisis that demands immediate attention and intervention.

Various factors have contributed to this significant rise in excess deaths related to cardiovascular disease. In the initial stages of the pandemic, COVID-19 infections were responsible for driving high numbers of fatalities among individuals with pre-existing heart and blood vessel conditions, such as heart attacks and strokes.

Although the number of deaths from COVID-19 has declined year-on-year, deaths involving cardiovascular disease have remained persistently high, surpassing expected levels.

The analysis conducted by the OHID indicates that deaths from cardiovascular disease have surpassed those of any other disease group. The staggering figure of 96,540 excess deaths since February 2020 serves as a distressing reminder of the severity of the situation.

To comprehensively address this crisis, it is crucial to identify and acknowledge the major factors that are driving the ongoing increase in deaths related to cardiovascular disease.

One critical factor contributing to this dire situation is the severe and continuous disruption to NHS heart care. The overwhelming pressure exerted on NHS services due to the pandemic has strained resources and compromised the delivery of essential cardiovascular treatments and procedures.

The record-high number of nearly 390,000 individuals waiting for time-sensitive cardiac care at the end of April in England is a testament to the overwhelming demand that is not being met. Delayed access to heart care places patients at increased risk of avoidable hospital admissions, heart failure, and premature death.

The analysis also sheds light on the detrimental impact of COVID-19 on the risk of heart attack and stroke. Studies conducted prior to the widespread vaccine rollout have revealed that individuals, both with and without pre-existing heart conditions, who contracted COVID-19 were 40% more likely to develop cardiovascular disease.

Furthermore, the risk of death within 18 months after infection increased fivefold for these individuals, with an even higher risk for those who experienced severe COVID-19 symptoms. These findings highlight the urgent need for interventions that address the long-term consequences of COVID-19 on cardiovascular health.

In light of these concerning developments, the British Heart Foundation (BHF) is calling upon the UK Government to assume a leading role in addressing this urgent cardiovascular disease crisis. Dr. Charmaine Griffiths, Chief Executive of the BHF, expressed deep concern for the significant loss of lives and emphasized the need for immediate action. She stressed that without substantial changes, the escalating death rates from cardiovascular conditions could undermine the progress made over decades in reducing heart attack and stroke mortality.

To combat this crisis effectively, the BHF advocates for a comprehensive and coordinated approach that focuses on three critical fronts: prioritizing NHS heart care, intensifying efforts to prevent cardiovascular disease, and advancing cardiovascular research to unlock groundbreaking treatments and potential cures. These measures would provide heart patients and their loved ones with hope for a healthier future while addressing the current challenges head-on.

However, the path to resolution is fraught with challenges. The analysis reveals alarming statistics that illustrate the extent of the problem. Average ambulance response times for heart attacks and strokes have consistently exceeded the target of 18 minutes since the beginning of 2022, breaching 90 minutes in December of the same year.

The strain on NHS resources, coupled with reduced detection and management of risk factors like high blood pressure, has exacerbated the situation further. NHSE figures indicate that in 2021, 2 million fewer people were recorded as having controlled hypertension compared to the previous year.

While progress has been made in addressing the cardiovascular disease crisis, it is evident that bolder and faster action is required. The BHF urges the UK Government to make a specific and long-term commitment to expedite improvements in cardiovascular care, both now and in the future.

This commitment should encompass an increase in the cardiovascular workforce to tackle the backlog of work and long waiting lists for treatment, alongside a robust public health strategy that promotes healthy behaviors and prevents heart disease at its roots.

The need for immediate action is underscored by Professor John Greenwood, President of the British Cardiovascular Society (BCS). He emphasizes that COVID-19 has had wide-ranging effects on cardiovascular health, including direct, indirect, and long-term consequences. The BCS recommends urgent prioritization of cardiovascular disease prevention and treatment, as well as an expansion of the cardiovascular workforce across primary and secondary care. Furthermore, a strong public health strategy is essential to educate and empower individuals to adopt healthy behaviors that prevent heart disease from developing in the first place.

The analysis released by the OHID builds upon last year’s report, “The Tipping Point,” which highlighted the profound impact of the pandemic’s legacy on heart patients. The inclusion of broader disease categories, such as cardiovascular disease, in the OHID’s data provides a comprehensive understanding of the excess deaths involving all heart and circulatory conditions since the onset of the pandemic. It is imperative to recognize that these statistics account for an aging and growing population, magnifying the urgency of the situation.

In conclusion, the analysis’s findings paint a grim picture of the cardiovascular disease crisis exacerbated by the COVID-19 pandemic in England. The alarming increase in excess deaths involving cardiovascular conditions demands immediate action from the UK Government.

By prioritizing NHS heart care, intensifying efforts to prevent cardiovascular disease, and advancing cardiovascular research, it is possible to reverse the disturbing trend and provide hope for a healthier future. The time to act is now, as every delay risks further loss of lives and undermines decades of progress in tackling heart disease and stroke.


in deep…..

The Impact of COVID-19 on Cardiovascular Disease
COVID-19 is a global pandemic that has affected millions of people worldwide and caused hundreds of thousands of deaths. COVID-19 is caused by a novel coronavirus called SARS-CoV-2, which infects cells through the angiotensin-converting enzyme 2 (ACE2) receptor. The ACE2 receptor is expressed in various tissues, including the lungs, heart, blood vessels and kidneys.

COVID-19 can interact with the cardiovascular system in multiple ways, increasing the risk of severe illness and death in patients with pre-existing cardiovascular disease (CVD) and causing myocardial injury and dysfunction in some patients without prior CVD. In this article, we will review the current evidence on how COVID-19 affects the cardiovascular system and discuss the implications for prevention and management of CVD in the context of the pandemic.

How COVID-19 Increases the Risk of Severe Illness and Death in Patients with CVD
Patients with CVD are more vulnerable to COVID-19 complications and have a higher mortality rate than patients without CVD. According to a meta-analysis of 18 studies involving 46,248 patients with COVID-19, the prevalence of CVD among patients with COVID-19 was 12.89%, and the mortality rate among patients with CVD and COVID-19 was 10.25%, compared with 1.38% among patients without CVD and COVID-19.

There are several possible mechanisms by which COVID-19 may increase the risk of severe illness and death in patients with CVD.

  • First, COVID-19 may cause direct myocardial injury by infecting cardiomyocytes through the ACE2 receptor, leading to inflammation, apoptosis and necrosis of cardiac cells. This may result in acute myocardial infarction, myocarditis, heart failure or arrhythmias.
  • Second, COVID-19 may cause indirect myocardial injury by inducing a systemic inflammatory response syndrome (SIRS), which may trigger plaque rupture, thrombosis, endothelial dysfunction and oxidative stress.
  • Third, COVID-19 may exacerbate underlying CVD by causing hypoxemia, hypotension, fluid overload or renal impairment.
  • Fourth, COVID-19 may interfere with the optimal management of CVD by disrupting access to health care services, delaying diagnosis and treatment, or causing drug shortages or interactions.

How COVID-19 Causes Myocardial Injury and Dysfunction in Patients without Prior CVD
COVID-19 can also affect the cardiovascular system in patients without prior CVD, causing myocardial injury and dysfunction that may have long-term consequences. A large cohort study of 153,760 US veterans who survived the first 30 days of COVID-19 found that they had increased risks of incident CVD spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks were evident even among patients who were not hospitalized during the acute phase of COVID-19 and increased according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care).

The mechanisms by which COVID-19 causes myocardial injury and dysfunction in patients without prior CVD are similar to those described above for patients with CVD. However, some factors may be more prominent in this population, such as SIRS-induced cytokine storm, coagulopathy and microvascular thrombosis. Additionally, some patients may have genetic or environmental predispositions that make them more susceptible to cardiac complications from COVID-19.

How to Prevent and Manage CVD in the Context of COVID-19
The prevention and management of CVD in the context of COVID-19 require a multidisciplinary approach that involves public health measures, individual risk assessment and modification, pharmacological and non-pharmacological interventions, and follow-up care.

Public health measures include vaccination against COVID-19, infection control practices such as wearing masks and social distancing, testing and tracing strategies for early detection and isolation of cases, and provision of adequate health care resources and personnel for managing both COVID-19 and CVD.

Individual risk assessment and modification include identifying patients with CVD or at high risk of CVD who may benefit from more frequent monitoring or prophylaxis for COVID-19 complications. These include patients with heart failure, coronary artery disease, valvular heart disease or atrial fibrillation. Risk factors for CVD such as hypertension, diabetes, dyslipidemia, obesity and smoking should be optimally controlled to reduce the severity and mortality of COVID-19.

Pharmacological and non-pharmacological interventions include continuing or initiating evidence-based therapies for CVD, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, statins, anticoagulants and antiplatelets. There is no evidence that these drugs increase the risk of COVID-19 infection or severity, and they may have beneficial effects on the cardiovascular system.

However, some drugs may require dose adjustment or monitoring in the setting of COVID-19, such as diuretics, renin-angiotensin-aldosterone system inhibitors and anticoagulants. Non-pharmacological interventions include lifestyle modifications such as physical activity, healthy diet, stress management and smoking cessation.

Follow-up care includes providing adequate support and education for patients with CVD who have recovered from COVID-19, as they may have persistent symptoms or sequelae that affect their quality of life and prognosis. These include fatigue, dyspnea, chest pain, palpitations, depression and anxiety. Patients with COVID-19 who have developed new or worsening CVD should also be followed up closely to assess their cardiac function and need for further interventions.

Conclusion
COVID-19 is a major threat to the cardiovascular system, increasing the risk of severe illness and death in patients with CVD and causing myocardial injury and dysfunction in some patients without prior CVD. The prevention and management of CVD in the context of COVID-19 require a comprehensive approach that involves public health measures, individual risk assessment and modification, pharmacological and non-pharmacological interventions, and follow-up care. Further research is needed to better understand the mechanisms, risk factors and long-term outcomes of COVID-19-related cardiovascular complications.


reference link :https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2023/june/100000-excess-deaths-cardiovascular-disease

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