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In the spring of 2020 - long before the first COVID vaccine was produced - we were already seeing evidence of the impact of acute SARS-CoV-2 infection on the cardiovascular system.
While most of these cases were never tested for COVID-19, this trend became so pronounced that the city ordered new Standards Of Care During A Pandemic: CPR & Cardiac Arrest, limiting the use of CPR in the field.In early April 2020, the New York Fire Department reported a 400% increase in sudden cardiac arrest death calls beginning in late March (see NBC affiliate Massive Spike in NYC ‘Cardiac Arrest’ Deaths Seen as Sign of COVID-19 Under counting).
Also in April 2020 we saw reports such as:
EID Journal: Pulmonary Embolism and Increased Levels of d-Dimer in COVID-19 PatientsIn June, JAMA published an original investigation which found a huge increase in out-of-hospital cardiac arrests in New York City during the peak of their COVID-19 epidemic, writing:
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication
From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year.
While many of these cases already had underlying cardiac problems, COVID-19 appears to have a direct, and often serious impact on cardiac function.
The following month, in JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury, we saw physical evidence of cardiac injury due to COVID infection, even among a relatively young cohort of previously healthy adults.
By mid-summer, it was apparent that COVID was far more than just a respiratory infection (see Nature Med. Review: Extrapulmonary manifestations of COVID-19), and could produce blot clots, along with neurological, renal, and cardiovascular damage.
In late July we saw this cautionary editorial published in JAMA.
Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
Since then we've seen a steady stream of related studies, all pointing to both acute and chronic cardiovascular impacts from (often repeated) COVID infection. A few (of many) include:
Nature: Long-term Cardiovascular Outcomes of COVID-19Most people are familiar with the more obvious signs of `Long COVID' (see CDC list below):
AHA: COVID-19 May Trigger New-Onset High Blood Pressure
NIH: Study Shows SARS-CoV-2 Infects Coronary Arteries, Increases Plaque Inflammation
EHJ: Accelerated Vascular Ageing After COVID-19 Infection: The CARTESIAN Study
But there are also more insidious health impacts that may not fully manifest for years (e.g. Hypertension, Cardiac problems, Diabetes, Neurodegenerative diseases like `Parkinson's', etc.), or only after repeated infections.
While the evidence of harm is compelling, all of this is terribly inconvenient for a world that is desperate to `move on' from the COVID pandemic, and treat the virus as a relatively trivial seasonal virus.
Today the European Society of Cardiology has released a lengthy consensus statement on the impact - and potential treatment - of chronic COVID-related cardiovascular disease.
Although free to view, this paper is copyrighted, and so I've only provided a link, and excerpts from a couple of press releases. Follow the links to read them in their entirety.
I'll return with a postscript after the break.
Cardiovascular disease prevention and management in COVID-19: a clinical consensus statement of the European Association of Preventive Cardiology, the European Association of Cardiovascular Imaging, the Association of Cardiovascular Nursing & Allied Professions, the European Association of Percutaneous Cardiovascular Interventions, and the Heart Failure Association of the ESC
Vassilios S Vassiliou, Vasiliki Tsampasian, Maria Luiza Luchian, Flavio D’Ascenzi, Fabrizio D’Ascenzo, Marc R Dweck, Javier Escaned, Sabiha Gati, Martin Halle, Konstantinos C Koskinas ... Show more
European Journal of Preventive Cardiology, zwaf540, https://doi.org/10.1093/eurjpc/zwaf540
First, this press release from the European Society of Cardiology.
Key take-aways:
- Covid infection and long Covid have serious effects on the heart and blood vessels, and the pandemic has had a widespread and lasting impact on cardiovascular health.
- A set of expert recommendations explain how these conditions should be diagnosed, treated and prevented.
- Cardiac rehabilitation is vital for Covid and long Covid patients, but many do not have access to rehabilitation programmes.
Millions of people around the world are suffering with the serious cardiovascular effects of Covid infection and long Covid. A lack of clear guidance on how to reduce this suffering and prevent further harm means that patients are not receiving the care they need, and some are turning to unproven or unsafe treatments.
- Vaccination reduces the cardiac risks of Covid, so vaccination programmes must continue.
A major report published in the European Journal of Preventive Cardiology [1] today (Thursday), sets out how to address this growing problem through diagnosis, treatment, rehabilitation and vaccination.
The report is a clinical consensus statement authored by a group of experts from across Europe, led by Professor Vassilios Vassiliou from University of East Anglia and Norfolk and Norwich University Hospital, UK, on behalf of the European Society of Cardiology (ESC).
Professor Vassiliou said: “Covid-19 has a profound and lasting impact on cardiovascular health, with complications emerging during acute illness, recovery, and even after reinfections or vaccination. In the absence of clear evidence-based guidance, patients risk harmful treatments and clinicians face uncertainty.
(SNIP)
Almost one billion people are known to have been infected with Covid-19 worldwide, although the true number is believed to be far higher, and research shows that Covid patients, especially those who needed hospital treatment, have a higher risk of cardiovascular disease, including heart attack, stroke and death from cardiovascular disease.
Researchers estimate that around of 100 million people are currently living with long Covid, and about 5% of these (five million) will have cardiac long Covid, with symptoms including angina (chest pain), breathlessness, arrhythmia (abnormal heart rhythm), heart failure, fatigue and dizziness. Long Covid can also lead to autonomic dysfunction where the nerves that normally control heart rate, breathing and body temperature do not work properly.
The expert consensus statement includes advice to continue vaccinating against Covid-19, as people who are fully vaccinated are far less likely to suffer cardiac complication or long Covid, even if they develop a Covid infection. They also set out how to diagnose and treat the symptoms brought on by Covid, such as shortness of breath, chest pain and fainting. In particular, the paper recommends structured cardiac rehabilitation programmes, including specialised physiotherapy, to prevent longer term problems from developing following infection and to aid recovery from long Covid.
This press release from the University of East Anglia:
Major report tackles Covid’s cardiovascular crisis head-onWhile there are proven ways to reduce the risk of COVID infection (updated vaccines, wearing face masks in public, avoiding indoor crowds, etc.), most people - at least for now - apparently can't be bothered.University of East Anglia
Regular Covid vaccinations should continue worldwide to reduce cardiac risks associated with the virus - according to new research from the University of East Anglia.
A major report published today sets out ways of tackling the ‘profound and lasting impact’ of Covid and long Covid on cardiovascular health.
It makes recommendations for diagnosing, treating and preventing serious heart and blood vessel complications linked to the virus.
As well as continuing vaccination programmes, the report recommends structured cardiac rehabilitation - to prevent long-term problems after infection and boost long Covid recovery.
The clinical consensus statement is authored by a group of experts from across Europe, led by Prof Vassilios Vassiliou from UEA and the Norfolk and Norwich University Hospital on behalf of the European Society of Cardiology (ESC).
(Continue . . . )
A calculated risk that will undoubtedly work out for many, but will be devastating for some. The problem is, you can never know into what group you will fall.
Which is why I continue to wear an K/N95 mask in public, and hope that COVID vaccines will remain available for all those who want them going forward.
