Study by the Italian Society of Cardiology on 45 hospitals in the country
The pandemic risks setting the clock of cardiology back decades: due to the latest Covid-19 emergency, which forced the conversion of many cardiological beds to treat infected patients, in many hospitals cardiological assistance has been reduced to the bone and mortality from heart attack and stroke is now in danger of returning to the levels of 20 years ago. He is reported by asurvey conducted by the Italian Society of Cardiology in 45 hospitals equally distributed throughout the country: the survey showed that 68% of hospitals reduced the elective admissions of heart patients, 50% decreased the supply of diagnostic tests and 45% had to cut outpatient visits. 22% even had to reduce the number of beds in ICU (ICU), while 18% of the hospitals reduced the number of medical personnel in ICU and 13% in nursing.. However, a reversal of course is necessary that guarantees a restoration and perhaps an enhancement of cardiological assistance, also because in the future cardiological patients could increase precisely because of Covid: a study recently published in Nature Medicine demonstrates that after the recovery from ‘infection patients have an increased risk of cardiovascular diseases such as heart failure, stroke, heart attack, arrhythmias and myo-pericarditis. “These are very worrying data, which testify to an evident emergency situation for Italian patients with cardiovascular diseases”he claims Ciro IndolfiPresident of the Italian Society of Cardiology and Vice-President of the Confederation of Cardiologists, Oncologists and Hematologists (FOCE) and Director of the Complex Unit of Cardiology and Utic, Magna Graecia University of Catanzaro.
For the Italian survey, the activities in the cardiology field of 45 hospitals belonging to the SIC were monitored in two different phases, in November / December 2021 and then in January 2022. These findings indicate a severe downsizing of cardiac care in many health care facilities, an indirect ‘side effect’ of the pandemic that risks taking a high price to pay. “The omicron variant and the vaccine have significantly reduced the severe forms of Covid 19 and the need to end up in resuscitation, while the direct and indirect consequences of the pandemic on cardiovascular diseases are unfortunately still widely underestimated. – points out Indolfi – The need for recruitment of available places for Covid 19 patients, often used to guarantee the lack of progression in the orange or red zones, the lack of planning in the previous months and the emergency decisions have led to a health reorganization that has penalized many cardiologies throughout the country : coronary angioplasty, percutaneous implantation of heart valves, procedures for the implantation of pacemakers and defibrillators, ablations have decreased; electrocardiograms, echocardiography and exercise tests were reduced. All this is alarming: heart patients have no longer found adequate assistance for the prevention and treatment of their diseases.“. Concern is also growing because many data show that a surge in cardiology patients is possible after the pandemic: “A study published in Nature Medicine and conducted on more than 150,000 patients recovered from Covid-19 compared to over 5 million healthy controls has shown that after the infection the risk of cardiovascular diseases increases significantly, even in those under the age of 65 without risk factors such as obesity or diabetes – continues Indolfi – For example, patients recovered from Covid were 52% more likely to have a stroke: for every 1,000 people studied, therefore, about 4 more stroke victims were recorded among those infected with the virus than in the control group. The danger of heart failure has increased by 72%, or about 12 more people for every 1,000 recovered from Covid “.
All this opens the way to a future in which we could go back to the past, when a much greater number of people died of a heart attack, also because alongside a downsizing of assistance, the pandemic itself has worsened the cardiovascular health of Italians. “Today there are 1 million more smokers than in the past, 44% of Italians have gained weight, excessive alcohol consumption has grown by 23.6% among males and 9.7% among women – states the Prof. Pasquale Perrone Filardi, President-elect of SIC and Ordinary of Cardiology, Federico II University of Naples – These data are very worrying and presage an increase in cardiovascular diseases in the coming years, to which is added the increase in ischemic heart diseases: Italy was the first Western nation to be affected by the pandemic and SIC was the first scientific society, in a study published in the European Heart Journal, to intercept this phenomenon already in the first phase of the pandemic, when a threefold increase in mortality from myocardial infarction was recorded “.
“In Italy cardiovascular diseases represent 44% of all deaths, ischemic heart disease is the main cause of death (28%) and 4.4 Italians per thousand suffer from cardiovascular disability – adds the Prof Gianfranco Sinagra, Vice-President of SIC and Full Professor of Cardiology University of Trieste – Despite the burden of cardiovascular disease, in 2016 the life expectancy at birth in Italy was 82.8 years, among the longest in the world; since the start of the pandemic, post-pandemic life expectancy has decreased to 82 years, with a further decrease of 1.2 years in 2020 compared to 2019. At 65, the expectation drops to 19.9 years (18, 2 years for men, 21.6 years for women): an effective prevention campaign is therefore needed and above all it is necessary to reorganize the therapeutic strategies in heart disease patients, without cutting back on their assistance as is happening instead “.
In the absence of a change of course to the acute effects of SARS-CoV-2 infection on the heart, we must add the indirect ones due to the lack of prevention and treatment of many cardiological diseases and those caused at a distance by the infection. “The data that emerged recall the need to protect heart disease patients, if we do not want to lose the extraordinary advantage obtained in cardiology in the last three decades: angioplasty for heart attack has reduced mortality from 30% to about 4%, but as hospitalizations and surgeries continue to decline, fewer and fewer heart attack victims will be able to access them. The new data also indicate that patients recovered from Covid must receive greater attention due to the increased probability of being affected by cardiovascular diseases: we are therefore at a time when less prevention and treatment of cardiovascular diseases is associated with greater own risk of these diseases in patients recovered from Covid. All this will have to be seriously considered in the next strategies for the reorganization of the National Health System “conclude Indolfi.