Tuesday 20th October 2020

In May this year, Heart Valve Voice conducted a survey of Valve Clinics in the UK to understand the impact of COVID-19 on their services and see how they adapted their practices to mitigate the rise in hospital admissions and reduction in treatment. Now, as we see infection rates and COVID-19 hospital admissions rise across the UK, we must learn from the past and limit the impact of the second wave on the NHS and valve disease patients. 

The survey, which you can read here, shows that during the first phase of COVID-19 there was a fall in patients presenting at primary care, a fall in referrals from primary care to secondary care, and a fall in heart valve disease treatments. To limit the impact of COVID-19, many clinicians opted for therapies which require a shorter hospital stay and allowed them to continue to treat patients in a timely and safe way.  Patients should be assured that deviations from standard treatment pathways will 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.

Based on our findings, Heart Valve Voice has a Three-Point Pan for valve disease care during the second wave of COVID-19. 

  1. Go to the doctor 

One of the most concerning trends during the first wave of COVID-19 was a reduction in patients presenting due to fear of COVID-19.; Patients must not let their fear of COVID-19 prevent them from seeking treatment for the life-threatening symptoms of heart valve disease. Any delay in responding to deterioration in your symptoms could be life-threatening. Patients must have confidence in their health service. It is safe, all precautions are in place to contain the virus, and the service continues to work for you. We saw the impact of the JustGo Campaign this summer, and now we need to reignite that message and make sure that every patient whose symptoms deteriorate gets the treatment they need.

Patients must have the confidence to respond immediately if they're experiencing heart problems. At Heart Valve Voice, we have Patient Stories from during the first wave, and I encourage all patients to read them and get a window into the quality of care patients have continued to receive during COVID-19. 

  1. Refer patients 

In our survey, over 90% of clinicians reported a reduction in referrals from Primary Care. Many of the clinicians reported this drop due to patients not presenting, which is why patient confidence is so important. However, Primary Care must also have the belief that Heart Teams can treat and the confidence to refer swiftly. We need to make sure there is a smooth passage from Primary to Secondary Care. GP's should refer patients speedily, as delays in treatment merely lead to worse outcomes. The capacity is there, so we need to refer. 

While our response to the first wave presented unknowns, our understanding of the virus has improved, and our capacity to manage both containing the virus and continuing to treat patients has improved significantly. So GP's need to have the confidence to refer, to remove the risk of a bottleneck of referrals. 

  1. Reassess treatment options 

Lastly, the Heart Team should consider local waiting times for surgery and transcatheter treatments such as TAVI or Mitral Clip. Minimally invasive procedures do not require a stay in intensive care and involve a shorter hospital stay, potentially increasing capacity and thus allowing the treatment of more patients. Our survey illustrates that many clinicians opted for these solutions in the first phase of COVID-19 response, and data from valve clinics shows that transcatheter therapies have enabled them to continue to treat certain valve disease patients in a timely and safe manner and with little to no risk infection from COVID-19. We know these solutions work, and they're safe, so they should be utilised in areas where they can increase capacity, and there is a local need.

Ultimately, the impact of our response to the second wave of COVID-19 relies on the work of the entire valve disease community. Patients and their friends, families or carers must be able to put their fear of COVID to one side and respond to any deterioration in theirs or their loved one's symptoms immediately. Primary Care clinicians must refer patients through to treatment in a timely way, and Secondary Care must maximise treatment capacity by utilising all treatment options available to them. At Heart Valve Voice, we will support the entire valve disease community and ensure that as a conduit to the NHS, we can improve the treatment of valve disease during the second wave of COVID-19.