COVID-19’s Lasting Impact on CV Disease Prevention

By Amit Khera, M.D., M.Sc.

Professor of Internal Medicine
Director, Preventive Cardiology

The acute cardiovascular (CV) effects of COVID-19 are top of mind for CV specialists, and CV disease prevention considerations are coming into sharper focus. Recently, at the AHA Scientific Sessions, I was asked to present my views on the potential lasting impact of COVID-19 on preventive care, which I will here summarize.

We are witnessing the repercussions of those avoiding urgent care for acute CV syndromes, with a 23% reduction in emergency room visits for myocardial infarction and 20% reduction for stroke. Thus, we can anticipate seeing growing numbers with chronic and debilitating CV disease from missed acute treatment opportunities. Further, the COVID-19 pandemic has been a great “stress test” on our health care system, exposing major cracks and flaws in prevention. Due partially to worse CV health and increased risk factor burden, there are disproportionate severe infection rates and death among Blacks, Hispanics, and Native Americans. COVID-19 has been a call to action to the prevention community to help eliminate racial and ethnic disparities in CV risk factors, as well as to create a healthier and more resilient population in general. It is anticipated that between 2.5 million and 8 million individuals could lose health care coverage due to COVID-19, making this task more challenging.

In primary prevention, the picture of COVID-19’s effects is less clear. With social distancing, work from home, and lock downs, there have certainly been changing patterns in lifestyle habits. Data from apps around the world and survey questionnaires show reduced step counts but also an increase in running, gardening, and online exercise classes. Further, early data suggest some favorable dietary aspects, including more home cooking and increased consumption of fruits and vegetables, but this is offset by more snacking and high glycemic index carbohydrate increase. Whether these changes are beneficial or harmful for CV health, and if they persist after the pandemic, remains to be seen.

Finally, there have been many rapid changes in care delivery, including the brisk uptake of telehealth, expanded use of remote monitoring, and enhanced access for patients to receive preventive care. In one national sample, telehealth comprised nearly 14% of outpatient visits at the peak of the pandemic’s first wave; however, the quality of this care is unclear. One health care database has demonstrated significantly lower blood pressure and cholesterol assessments in telehealth visits vs. in-person visits.

Ultimately, the lasting effects of COVID-19 on CV prevention largely depend on our response to what we have seen and learned. If we harness the positive changes in lifestyle habits, commit to addressing the exposed disparities in CV health, and learn to apply new care-delivery tools effectively, we will make important advances in preventing death and disability from CV disease in the future.

Follow Dr. Amit Khera:

Twitter: @dramitkhera