“Life may be on pause. Your health isn’t.”
This simple message came from a group representing the six largest health providers in Los Angeles County. Both the message, and the fact that it was a combined effort from groups that are more often viewed as aggressive competitors, speaks to the manner in which this pandemic has put both patients and providers into a situation that they simply could not have foreseen.
Just a few months ago, almost all patients would quickly seek medical care if they were experiencing chest pain or another symptom possibly indicative of a heart attack. But today, multiple providers around the world have reported on the alarming drop in patients presenting with acute cardiac events during the COVID-19 pandemic:
- Globally: 50% decrease in patients experiencing ST-elevation myocardial infarctions (STEMI) seeking hospital care, based on responses from 3,101 healthcare providers in 141 countries
- Northern Italy: 30% decrease in admissions for acute coronary syndromes (ACS)
- 9 Leading US Heart Centers: 38% decrease in acute PCIs for patients experiencing ST-elevation myocardial infarctions (STEMI)
- Northern California: 48% decrease in admissions for acute myocardial infarctions, including STEMI and NSTEMI
Unfortunately, for too many patients who delayed coming or never came to the hospital for cardiac symptoms, the opportunity passed for health care providers to make a difference. This should be a startling wake up call for all of us.
It was encouraging, however, to see recently published harmonized guidance led by the ACC and AHA that discussed how we will ensure that physicians can make a difference for those who may experience an acute cardiac event in the days, weeks, and months to come, even as uncertainty around COVID-19 remains. The guidance, which included input from no less than 15 North American clinical cardiovascular societies, was a thoughtful effort to balance ethical, safety, and public health demands.
So what did they say? How do we move forward? By working to maximize benefits carefully in terms of lives, or life years, clinicians can prioritize care for those patients who cannot safely be postponed. Other recommendations were to minimize physical contact between patients and healthcare providers, incorporate more virtual visits, streamline invasive procedures, and conserve PPE for the most urgent cases.
As I considered this guidance, it reinforced for me why cardiac CT should be at the center of that effort for many patients. Whether as part of an emergency department clinical pathway to provide a so-called quadruple rule-out (pulmonary embolism, aortic aneurysm, CAD, COVID-19) or to assess recurring typical angina in an outpatient setting, cardiac CT minimizes direct patient-staff contact, yet still enables physicians to confidently move toward treatment with increased understanding of each patient’s individual risk.
In the same way that providers are partnering in ways unforeseen 90 days ago, I am encouraged to see how these efforts to hear and learn from clinical data and experienced voices will change cardiac patient care moving forward. Of course, our future will look different than our past. But as clinicians, provider groups, and patients move forward arm-in-arm, we will have opportunities to deliver changes that will be better for all.