Lockdowns during the coronavirus disease 2019 (COVID-19) pandemic caused a massive decline in patients seeking cardiology services at hospitals, according to research published in Open Heart.

UK researchers found that the number of patients presenting to cardiology services at National Health Service (NHS) hospitals dropped by more than 50%. One center in Scotland even noted that the number of diagnosed heart attacks fell by 40%.

In accordance with government recommendations during the pandemic, cardiology services began offering virtual outpatient clinics, redeployed staff to acute medical services, and rescheduled non-urgent procedures. Cardiology experts also began focusing on the cardiac complications of COVID-19, which can include myocarditis, heart attack, and heart failure.

In an effort to understand how these changes affected cardiology services and clinical activity, researchers analyzed key performance indicators in a district general hospital and a supporting tertiary service both before and after lockdown. Although their research focused only on these 2 centers, the study authors pointed out that their findings are consistent with other research on the health consequences of lockdown measures. Therefore, they believe that similar changes will be observed in other medical and surgical specialties.

Investigators compared 4 different time intervals, each a month long, between January and May 2020. They noted significant reductions in every area of service provision, including outpatient clinics, investigations, procedures, and specialist community services, such as heart failure and cardiac rehabilitation.

During the first month of lockdown, the number of patients seen for chest pain and breathlessness fell sharply. Cardiology ward and cardiology care unit admissions plummeted from 83 to 39, a 53% drop. Similarly, the authors said the number of patients diagnosed with a heart attack fell from 30 to 18.

The investigators also noted a significant decrease in the number of acute cardiac tests performed, including a 46% drop in cardiac troponin T blood tests and an 87% reduction in 12-lead EKGs. Inpatient ECG tests also fell from 77 to 43 during lockdown, a 44% reduction.

Similar to other studies, the authors found a sharp increase in use of virtual clinics alongside the decrease in inpatient clinics. The number of patients referred from primary care to cardiology outpatient clinics fell by 80%. As a result, the authors found that face-to-face clinic utilization dropped by 93%.

They noted various explanations for these changes, including the restructuring and prioritization of NHS services, reduced access to primary care, and patients’ reluctance to seek medical help due to fear of catching COVID-19.

“At the height of the pandemic, it is acceptable to deviate from the standard level of care and agreed guidelines in order to prioritize the delivery of essential services,” the authors said in a press release. “However, adverse consequences for some patients presenting with worsening of their underlying cardiac conditions have been inevitable. Consequently, cardiology services should be ready to offer them urgent input and early intervention.”

REFERENCE
50% drop in patients attending cardiology services during coronavirus lockdown [news release]. EurekAlert; August 26, 2020. https://www.eurekalert.org/pub_releases/2020-08/b-5di082520.php. Accessed August 31, 2020.