With CoViD-19 dramatically resurging and the nation in lockdown, the British Society for Heart Failure (BSH) urges the rapid roll-out of COVID-19 vaccination. “It is crucial to protect the most vulnerable members of our society particularly those with long term conditions such as heart failure”, said Dr Simon Williams, Chair of the BSH.
According to newly published research in ESC Heart Failure, a journal of the European Society of Cardiology (ESC), patients with acute heart failure nearly double their risk of dying if they get CoViD-19. This small, Bristol based study once again emphasises the need for patients with heart failure to take extra precautions to avoid infection.
“Heart failure (HF) is the endpoint for most cardiovascular disease, with HF patients at significantly higher risk of having adverse outcome from SARS-COV2 disease (CoViD-19) said British Society for Heart Failure (BSH) Chair, Dr Simon Williams. “The results of this study further support the need to prioritise heart failure patients for CoViD-19 vaccination and the importance of encouraging those with heart failure who are eligible to accept the vaccine when offered. We [BSH] have drafted a position statement on the CoViD-19 vaccination to help guide healthcare practitioners caring for those with heart failure – this can be accessed on the BSH website”. He concluded: “In the meantime, heart failure patients of all ages should be considered a high-risk group and be encouraged to follow Government advice by maintaining social distance and wearing a face mask to prevent infection.”
Heart failure refers to progressive weakening of the heart’s pump function with symptoms of breathlessness, ankle swelling and fatigue. Sudden and severe worsening of symptoms is called acute heart failure – this is a medical emergency and requires admission to hospital for intravenous medication and intensive monitoring.
Heart failure on the increase:
Heart Failure (HF) is a complex long term condition, rarely existing in isolation. There are approximately 1 million people with heart failure in the UK - 200,000 are newly diagnosed each year. It does not discriminate for creed, ethnicity, economic status or geography.
Yet the risk of complications from HF outweighs the risk of dying from CoViD-19 (Banerjee A et al. OurRisk.CoV; (as yet unpublished data, October 2020) but the CoViD-19 pandemic has made a devastating impact directly and indirectly on people with complex long term conditions such as HF. Excess deaths are being driven by cardiovascular diseases. There has been a rise in people with HF
due to suffering heart attacks and not accessing emergency care. The most striking drop in cardiovascular admissions however was seen for HF where a 66% drop in hospital attendance for HF up to April 2020 with no noticeable upturn yet seen in those with HF presenting to hospital. Across nine UK hospitals, a study published in the BMJ in October showed total admissions and emergency department attendances decreased after lockdown (23 March 2020) by 57.9% and 52.9% respectively, compared with the previous year. From the patient perspective, there was concern and anxiety: 32% of people with HF (of the 1050 who responded to a survey conducted by UK HF patient charity, Pumping Marvellous Foundation), expressed reluctance to attend hospital - 25% stated they would only attend hospital if there was no alternative and 7% stated that they would not attend hospital at all.
Dr Williams added: “People hospitalised with CoViD-19 are at increased risk of developing HF with heart damage occurring in at least 10 per cent of those admitted with infection and those with existing HF at higher risk of developing complications and death. The true impact is likely to be an underestimation as HF services have had staff redeployed to deal with the pandemic impacting on the care of both HF patients as in- and outpatients. However, whilst it remains a burdensome, debilitating condition and despite the threat of CoViD-19, it is possible to live well with heart failure. This is an important aim of the care provided by heart failure specialists.”