By Ileana Piña, MD, MPH, as told to Hallie Levine
During the pandemic, all of us cardiologists worried that heart failure cases would skyrocket, especially since so many people put off needed medical care. But in reality, we saw hospitalizations drop significantly. We think there are a few reasons why:
- People actually took their medications. We know that even patients who swear that they take their drugs all the time aren’t being completely truthful; they may skip a dose here or there. This is especially true for heart failure patients, who may be on four to five drugs, some of which need to be taken two or three times a day. But people were home, and more likely to stick to a schedule.
- People were eating less salt. Since most weren’t dining out as much and were cooking at home more, they were getting less sodium, which we know can make heart failure worse.
- People just took better care of themselves. No one wanted to end up in the hospital during the worst of the COVID-19 pandemic, so they did things like eat right, stay active, and follow their doctor’s instructions. They also may actually have gotten better medical care, because they were seeing their cardiologists regularly via telehealth, instead of struggling to make in-person appointments.
Unfortunately, this trend is short lived, as hospitalization levels are beginning to creep back up again as more and more people get back to normal life. But there are three important ways the pandemic changed heart failure treatment, and I hope they are all here to stay.
Research shows that telehealth prevented people from ending up in the hospital due to poorly controlled heart failure. Medicare has started to pay for these kinds of visits. So the pandemic has taught both doctors and patients that most routine care can be done by telehealth. You don’t have to waste gasoline and drive somewhere where it’s impossible to find a parking spot only to sit in a waiting room for hours. I can’t tell you how many cancelled appointments I had pre-pandemic because someone forgot an appointment, or didn’t have transportation, or was just too busy to take hours out of their day to come in.
Many people with heart failure need to see their doctor as often as every 2 weeks so that we can adjust their medications. But with telehealth, we can get a lot of information about whether or not treatment is working. We will notice if someone is short of breath, for example, and can check their feet and ankles for swelling. We can also have a person weigh themselves and take their blood pressure and pulse. It may not be as thorough as a physical exam, but we glean a lot just by talking to someone.
More Vaccine Compliance
If you have heart failure, you’re at very high risk of complications from COVID-19. We already know that this virus causes inflammation throughout the body, including the heart, which is bad news for someone with heart failure. Cardiologists worry that people who test positive for COVID-19 will go on to have heart inflammation later, even if they didn’t have severe symptoms at first.
Thankfully, most people seem conscientious about getting a COVID vaccine, and we hope this extends to other vaccines, too, like the flu or pneumococcal vaccines. We know people with heart failure are more likely to be hospitalized and even die if they get either of these conditions.
A Greater Focus on Advocacy and Self-care
Thankfully, heart failure programs nationwide really doubled down on taking extra special care of their patients during the pandemic. As a result, more people are involved in their care and speak up about what they need. That’s important for doctors, because oftentimes what we think they want, they don’t.
I was on a virtual panel recently where I learned that most people with heart failure break their days into good days and bad days, depending on how much fatigue, shortness of breath, and swelling they have. Their focus is on quality of life, instead of trying aggressive treatments to reverse their disease.
We’re concerned that, ultimately, we may see an influx of people with heart failure due to silent heart inflammation that happened after a COVID infection. We also know excess weight, especially in the belly, can be deadly for your heart. One study surveyed middle-aged men and women and found that on average they gained 1.5 pounds during the first months of the pandemic. If that trend continues, it’s a roadmap to obesity, which we know greatly raises the risk of heart failure.
That’s why it’s so important for people to take control of their health through steps like healthy eating, regular exercise, and good control of conditions such as high blood pressure. If they do, they’ll be able to stave off -- or just slow down -- the progression of heart failure.