COVID-19 Pandemic and Cardiovascular Challenges

The recent COVID-19 pandemic impacts different levels of modern society on an unprecedented level. From the perspective of cardiovascular medicine, the recent outbreak of the new coronavirus infection is associated with several major challenges that may influence our practice of medicine on a short or even longer term. Analysis of COVID-19 fatality rates in countries with a high number of infections indicate that people with cardiovascular diseases are most exposed to the risk of death following infection with the new coronavirus. For instance, analysis of a group of 355 COVID-19 patients who have died in Italy showed that 30% of them had ischemic heart disease, 35% had diabetes, 24.5% had atrial fibrillation, and 9.6% had stroke as pre-existing comorbidities.1 This is in line with the already documented link between cardiovascular comorbidities and fatality rates in infections with coronaviruses, and indicates that in the setting of a viral pandemic, cardiac patients represent a high-risk group that requires special attention and dedicated treatment strategies.2 Over the last decades, in the attempt to provide the most effective life-saving therapy for cardiac patients, international scientific societies have released many guidelines for the treatment of various heart diseases, which have been implemented in clinical practice on a large scale. However, adherence to guidelines in the COVID era may represent a serious challenge for cardiology practitioners, and failure to provide the most effective recommended therapy could be reflected in a significant increase of cardiovascular mortality in a very close future. One of the most surprising findings observed in all the countries facing the COVID pandemic is that the number of presentations with ST-segment elevation acute myocardial infarction (STEMI) has been reduced by 50–70%. The same is true for all the other types of cardiovascular emergencies (acute heart failure, hypertensive emergencies, pulmonary embolism etc.). This does not mean that the risk of heart attacks was reduced or that the population has cured from cardiovascular diseases. Moreover, it is well known that any infection, leading to increased systemic inflammation, is associated with a higher risk of acute cardiovascular events in people with underlying atherosclerosis. The significant reduction in cardiovascular emergencies presentations can be explained only by the fact that patients are scared to present to the hospital, which they consider to be a dangerous place. As a consequence, a significant proportion of patients with chest pain prefer to remain at home, and many of them will die at home or will develop post-infarction heart failure, with significant reduction in their quality of life and increased costs for their healthcare, on a long term. At the same time, as the outbreak appeared unexpectedly, there are no current guidelines released by scientific societies on how to manage STEMI or NSTEMI cases in the COVID areas. No network-based protocols for patient transfer and urgent admission to the cath lab seem to effectively function in COVID-affected regions, and there are even some suggestions to return to thrombolysis in order to protect both patients and physicians from infection. It is indeed sad that after spending three decades and a huge amount of resources for implementing network-based protocols for life-saving treatment in acute myocardial infarction, now we have to ignore guideline COVID-19 Pandemic and Cardiovascular Challenges