COVID-19 AND NEGLECT OF CARDIOVASCULAR DISEASES TREATMENT

Coronavirus was first reported as an acute respiratory syndrome in December 2019 in Wuhan, China. This infectious disease spreads rapidly in many countries , and humans worldwide, shows different symptoms of the disease. High fever, cough, and fatigue were the most common symptoms that patients with covid-19 showed.1 The COVID-19 pandemic has created unprecedented challenges for health care in many countries worldwide. In addition to patients, COVID-19 is very dangerous for health care staff at the frontline of fighting this disease. The large number of COVID-19 virus patients who need to be hospitalized puts a heavy burden on the health system of countries so the treatment of other diseases is seriously disrupted.2 Cardiovascular disease is one of the most important diseases that has been neglected due to the focus of the Covid-19 pandemic and its special conditions, including completing the capacity of clinical departments and full-time participation of hospital staff.3 Among various diseases, cardiovascular diseases are the most common and the main cause of death in the world (Estimated 17.9 million death each year) and the most important factor of disability (Generally, about eleven percent of the total disease burden).4 Despite significant advances in the field of medicine, one-third of patients who suffer from a heart attack (myocardial infarction) still die, and two-thirds of those who never survive fully recover and are unable to lead normal lives.5 There is a close relationship between COVID-19 and cardiovascular diseases so cardiovascular diseases are more common in patients with COVID-19, and these patients are at higher risk of death.6 Cardiovascular disease is associated with more severe symptoms of COVID-19 and higher mortality rates. COVID-19 can have primary cardiac involvement (arrhythmia, myocardial infarction, and myocarditis) and secondary cardiac involvement (myocardial damage/elevated biomarkers and heart failure). COVID-19 can have several effects on the cardiovascular system of patients. Acute cardiovascular complications can cause many challenges. For example, one of these challenges can be the need for a multidisciplinary heart and lung team to assess the condition of patients with severe symptoms.7,8 Currently, the outbreak of COVID-19 disease has created unprecedented pressure on patients, physicians, and in general, the health care systems of the world and led to delays in the treatment of cardiovascular patients. Delay or neglect of treatment of cardiovascular patients is associated with inevitable complications and mortality. Because the living conditions of many of them are threatening and dangerous.9 Some early signs of cardiovascular disease (shortness of breath, chest pain) in patients may be confused with COVID-19 symptoms, and the patient may be misdiagnosed.10 The COVID-19 pandemic has faced the world in a difficult position. Hospitals and health centers have been severely affected by treating patients with COVID-19. Governments are attempting to prevent further outbreak of this disease effectively. Of course, the important point is that governments should not neglect other health priorities, such as non-contagious diseases and cardiovascular diseases.11 While many efforts of medical staff to fight COVID-19 are understandable, hospitals should not forget their primary role in caring for other patients and neglecting their essential needs. Neglecting cardiovascular diseases such as congenital heart disease (CHD) and acute coronary artery syndrome will lead to irreparable damage.12 Health care systems must establish the right balance between treating patients with COVID-19 and treating cardiovascular diseases.13 It is suggested that to better control COVID-19 and balance the management of other diseases, only a certain hospital capacity should be allocated to this disease. Due to the lack of definitive treatment for COVID-19, treatment for other diseases should not be delayed. References Hsih W-H, Cheng M-Y, Ho M-W, Chou C-H, Lin P-C, Chi C-Y, et al. Featuring COVID-19 cases via screening symptomatic patients with epidemiologic link during flu season in a medical center of central Taiwan. J Microbiol Immunol Infect. 2020;53(3):459-66. Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, et al. EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. 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