No Time to Waste

 

Fears related to COVID- 19 have caused many people to ignore dangerous symptoms. Here’s why it’s more important than ever to stay in care.

By Rachel Hedstrom

David Clark is one of the millions of Americans living with heart disease. On March 24, 2020, as the pandemic became a reality across the country, Clark refused to let the virus rob him of life-saving care.

“I was having some strong symptoms of pain in the left arm. The big clue was that my blood pressure was really high every hour I checked it, so I knew,” recalls Clark, a member of Mended Hearts® in Southwest Florida. “It was definitely telling me something was wrong.”

When he began feeling faint, Clark asked his wife to drive him directly to the emergency room. Just 10 minutes into being triaged by the hospital’s medical team, he went into cardiac arrest. When he woke up in a hospital bed, doctors confirmed that had he waited just a few more minutes to get to care, he might not have lived.

Delaying Care and Dying

Clark is one of the fortunate ones who avoided becoming part of an alarming statistic last year. The study “Cardiovascular Deaths During the COVID-19 Pandemic in the United States,” published in the Journal of the American College of Cardiology, compared the death rate attributed to cardiovascular causes after the onset of the pandemic in the U.S. (March 18 to June 2, 2020) to the months before the pandemic and to the same period in 2019. During the pandemic, rates of cardiovascular disease diagnosis dropped, and deaths increased.

Rishi K. Wadhera, M.D., a cardiologist at Beth Israel Deaconess Medical Center, assistant professor at Harvard Medical School and lead investigator on the study, told Healthline that clinicians in regions hard-hit by COVID-19 noticed a drop in emergency cardiac needs.

“This prompted many of us to ask, ‘Where did all the heart attacks go?’ ” Dr. Wadhera says. “We worried that patients with urgent heart conditions were not seeking the medical care that they needed, potentially because they feared they might contract the virus if they came into the hospital.”

Fear of the coronavirus is shared by many Americans, particularly people with underlying conditions. Co-morbidities like cardiac disease, cancer, obesity, diabetes and even age are linked to increased risk of severe infection or death from COVID-19, according to the Centers for Disease Control and Prevention.

“This [pandemic] has been something that is so incredibly difficult,” says Patricia Keegan, DNP, NP-C, AACC, director of Strategic and Programmatic Initiatives at Emory Heart & Vascular. “You can understand why people are hesitant but, at the end of the day, the hospital is the safest place to seek care.”

The Importance of Preventative Care

Healthcare is not just for emergencies, Keegan emphasizes: “Preventative care is vitally important. Things can change quickly with ischemic or valvular heart disease, or hypertensive heart disease.”

How dangerous could it be to skip one visit? Experts agree that avoiding care can be potentially life-changing.

“A lot of our patients are on multiple medications that need to be monitored,” Keegan explains. “Work with your physician or advance practice provider to find out if you actually need to come into the office. Many times, [care] can be done remotely.”

Physician offices and hospitals are working hard to make sure that staying in care is as safe as possible, she says. Some patient visits can be conducted via video conference calls, and patients who come into the office will often be taken directly to an individual treatment room rather than remaining in a waiting room. Family members and friends are asked to stay home to minimize the number of people in medical care facilities.

“From a provider standpoint, we are also screened on a daily basis as we come into work,” Keegan says, adding that staff members wear personal protective equipment including masks and face shields to keep themselves and their patients safe when they provide hands-on care.

Most important to remember, Keegan emphasizes, is that the healthcare community’s goal is to keep their patients healthy. “This is my job. This is what I do. We all genuinely care about our patients and want to keep them safe,” she says.

When one of Keegan’s patients let a fear of acquiring COVID keep him from his scheduled preventative care appointment, she called him directly. “I said, ‘Let’s talk this out. How can we do this so that you feel comfortable?’ At the end of the day, we all want to work with our patients to get the best care possible, even if they don’t feel comfortable coming into the office at this time.”

According to a survey released by the Society for Cardiovascular Angiography & Interventions, nearly 40% of Americans do not feel safe going to the doctor’s office while COVID-19 is still a risk. A study published in JAMA Network found that this has resulted in a more than 20% decrease in primary care visits since the onset of the pandemic and a nearly 40% drop in patients seeking treatment for a life-threatening cardiac event called ST-Elevation Myocardial Infarction, according to a study published in the Journal of the American College of Cardiology.

The very real risk to patients in delaying or avoiding care is something that worries healthcare professionals like Keegan. “Stay up on your appointments so you don’t have medical emergencies,” she advises. “Our ICUs have patients in them who had delayed care and ending up needing critical care.”

How to Get to Care

When the news is filled with stories of hospitals being out of beds or that emergency rooms are full, how should patients plan to get to care?

“There is always room at the ER for emergencies,” Keegan explains. “Sometimes, hospitals don’t have bed availability, but if you ever have an emergency, you should always get emergency care.”

Keegan emphasizes that anyone with symptoms of chest pain, shortness of breath, loss of vision or other signs of a heart attack or stroke should call 911. Patients who have had cardiac events in the past and are experiencing symptoms similar to a previous event should get care immediately.

Keegan also reminds women that symptoms of a heart attack may manifest as something other than chest pain, such as pain in the jaw, the back or the belly.

“Symptoms could be earlobe to waist,” she says. “If it’s something new that doesn’t feel right, or if you have a feeling of impending doom, you could be having a heart attack.”

Clark’s hospital visit in March 2020 hasn’t been his only hospital experience during the COVID-19 pandemic. In addition to his follow-up care, Clark received cardiac catheterization in January 2021. “The hospital had me take a COVID test the day prior to admission,” he says. “I always felt comfortable when I was in the hospital.”

“Hospitals still have heart operating theaters and dedicated staff to take care of patients who present with heart disease. It may take some extra courage right now to go into a hospital. Make sure you stay safe and don’t compound the COVID situation, but if you have to go to the hospital, then GO!”

He says he wants heart patients to understand that specialists in cardiology are there for them. “I felt a little bit worried when I walked in and thought that the doctors should take care of the COVID patients, but I realize that there are doctors available to work with heart patients,” he says. “You may hear and realize that the doctors are under strain, but doctors like cardiologists, who are specialists in their field, have a practice and are still available to help heal people.”

Keegan talks to her patients about keeping themselves well during a pandemic — or any other day. Eating well, taking medications as prescribed, calling your provider with any questions or concerns, keeping medical appointments and getting vaccinations (if that is an option for you) are among the instructions she gives patients.

“Everybody is on the same page when it comes to whether you should stay in care,” she says, “and the answer is always yes.