Kate Cheema Q&A: Covid-19 and cardiovascular services

1. What has been the impact of Covid-19 on cardiovascular services?

There has been a cancellation of elective activity, a shift in how routine care is delivered, and a big backlog evident in secondary care. This has had obvious repercussions for individuals anxiously waiting for surgery or a diagnosis.

In March and April we also saw a huge drop in the numbers of people presenting with suspected heart attacks. This was really around people’s concern about being exposed to Covid or putting a burden on the NHS, but we could be setting ourselves up for increased prevalence of things like heart failure, as people have missed out on early interventions and diagnoses.

People who have a heart and circulatory condition are more at risk of a poor outcome if they do get Covid, but we’re also seeing emerging evidence that Covid itself could impact the heart and circulatory system irrespective of whether or not you have a pre-existing condition.

2. What can we learn from other data sources?

The ONS have been helpful, publishing mortality data at speed and in great detail, as well as data on excess deaths.

The BHF is funding seven key heart and circulatory disease Covid-specific projects, one of which seeks to link critical data sources together across pathways. One area where we don’t have enough insight is in primary care – there’s been work recently published that suggests primary care diagnoses of heart disease could be down around 43% in some areas. If we’re not identifying heart disease early in primary care, then ultimately those are the patients who end up very unwell in A&E.

3. Has there been anything positive to come out of this experience that you’ve learned or can take forward, either for the British Heart Foundation or the treatment of heart disease in the wider system?

The open sharing and discussion that we have been able to have across multiple data controllers, researchers and research groups – we’re seeing early research being made available much faster.

Projects like Open Safely and the BHF Data Science Centre have been incredibly useful in developing our heart disease lens, enabling us to get early sight on the impact of particular risk factors (like obesity and hypertension).

We’ve also got a really clear case of why the BHF, but also the nation more broadly, should be investing in data infrastructure and the analysts that bring that data to life. 

4. What’s been your biggest frustration?

We still have a really big focus on secondary care, even though the majority of heart disease care is delivered in primary care. By not looking at the whole system we’re missing a big bit of the picture.

I also don’t think we’ve been particularly good at helping people to act based on their individual risk, such as the blanket message of “stay at home” without giving people the tools to assess their risk properly. If you’ve got chest pain, are feeling really unwell and have a history of heart disease, you should be seeking help in hospital. That heart attack is going to be of much greater risk to you than the risk of catching Covid.

5. Thinking in the longer term (that could be the next few months or the next few years), what do you think the priorities should be for heart disease services?

Heart disease is particularly sensitive to changes in service delivery in the same way that cancer is – you can see very clearly the impact of closing down cancer services and we’re starting to see that same thing with heart disease.

The impact of losing routine care also concerns me. Managing hypertension, atrial fibrillation, keeping your blood pressure where it should be, managing your cholesterol – these are really important things to keep an eye on, but are the first to fall off the radar at times of crisis. I think the first priority should be opening services back up – if that’s not possible, there should be clear communication and alternatives.

Health inequalities have clearly been exacerbated by Covid. We were already seeing significant inequalities in heart disease – it accounts for around 25% of the difference in life expectancy between the most and least deprived in the UK. We want to make understanding the impact of inequalities for heart disease a priority.

*Kate Cheema is the Director of Health Intelligence of the British Heart Foundation.

Don’t forget to read the accompanying blog from the Nuffield Trust’s Rachel Hutchings on the impact of Covid-19 on cardiovascular services and patients.