Covid19 and Heart Valve Disease
Monday 19th October 2020
Across the country, COVID-19 infections continue to rise, and as the infection rates rise, so too do hospital admissions and, sadly, deaths. As we move forward in this second wave of COVID-19 response, we must learn from the first wave. For most people suffering from heart valve disease, the consequences of not being treated far outweigh the risk of contracting COVID-19 whilst in hospital. Therefore, the first lesson we should take from the first wave is to continue to treat heart valve disease patients in a timely and safe way.
At the very height of the COVID-19 outbreak, Heart Valve Voice surveyed UK Cardiac Clinicians in an attempt to understand how they had responded to the pressures placed on them by the pandemic. Key findings from the survey found that:
- 73% of cardiac clinicians saw a reduction in primary care referrals for heart valve disease
- Of those asked, 93% of clinicians attributed this to patients not presenting due to fear of COVID-19.
- In addition, 90% of clinicians have seen a drop in the number of patients referred for echocardiography
- 81% of those asked were considering alternative treatment options that require a shorter hospital stay in order to continue to treat patients safely and swiftly
Based on these learnings, Heart Valve Voice has a three-point plan for valve disease care for the next phase of our COVID-19 response.
- Go to the doctor - Patients should not let their fear of COVID-19 prevent them from seeking treatment for the life-threatening symptoms of heart valve disease.
- Refer patients - GPs should refer patients with symptoms of heart valve disease to secondary care (the heart clinics are ready to treat patients and know how to keep them separate to COVID-19 patients)
- Reassess treatment options – Multidisciplinary Heart Teams are expert in determining whether a less-invasive procedure, which can significantly decrease the number of days patients need to remain in a hospital, is appropriate under the current circumstances. Deviation from standard treatment pathways will only be suggested by Heart Teams when a treatment option carries a better overall outcome because of restrictions to usual pathways or when a balance of risk favours a less invasive option.
The survey found that patients were putting their lives at more risk by avoiding the hospital and necessary treatment over fears of contracting COVID-19. Patients are better-served taking all the required precautions and putting themselves in the hands of cardiac surgeons and cardiologists as the NHS doors remain open, hospitals remain safe, and heart disease treatments continue during these unprecedented times. Data from hospitals across the country shows the risk of catching COVID-19 in hospital is very low, and patients should have the confidence to act now if their symptoms deteriorate.
The reality is that the longer patients with severe valve conditions wait for treatment, the higher their risk of death, the probability of death rises from 3.7% at one month to 11.6% at six months of waiting. As waiting lists in the UK have increased over the past six months as a result of the coronavirus crisis, cardiovascular patients are at significant risk.
We must also ensure there is a smooth transfer of referrals from primary to secondary care to alleviate any surge of patients and reduce the risk of a bottleneck of referrals. Hospitals continue to have diagnostic and treatment capacity, and we need to build a bridge of confidence from primary to secondary care to streamline treatment pathways and make sure we are maximising treatment capacity. In addition to this, Heart Teams should consider local waiting times for procedures in their assessment of treatment options, and ensure they are maximising capacity and thus allowing the treatment of more patients.
While this second wave of COVID-19 presents unique challenges, those affected by heart valve disease should take comfort and confidence that our understanding of COVID-19 has improved significantly since the beginning of the outbreak. The structures to treat and contain the virus in hospitals has improved considerably, and our capacity to maintain other treatments while managing the outbreak has improved. Despite these pressures, valve disease treatments will continue, and the NHS will remain open for all patients throughout the coming months.