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Cardiovascular health and COVID-19: time to reinvent our systems and rethink our research priorities

Global trends in cardiovascular health have reached a worrisome inflection point. Decades of innovation led to a slew of drugs, devices and programmes that translated into reduced mortality from cardiovascular diseases in many countries. Unfortunately, progress on cardiovascular mortality since 2010 has slowed; in some countries, it has even reversed.1 Compounding the problem, political actions on cardiovascular health have been inadequate, and health systems across many low-income and middle-income countries are woefully under-resourced to scale up basic cardiovascular services. These factors could increase global health inequalities in coming decades.2 

Cardiovascular practitioners are now under greater pressure to deliver the same or better care in the context of a pandemic. COVID-19 has hit cardiovascular care particularly hard: WHO surveys recently found that cardiovascular services have been partially or completely disrupted in nearly half of countries with community spread of COVID-19, raising the chance of increased cardiovascular mortality in these locations.3 

Two studies published in this issue of Heart shed more light on the specific effects of COVID-19 on health systems in Brazil and the UK. Brant et al looked at cardiovascular mortality in six Brazilian capital cities.4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals.5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand: the restructuring of hospital services to cope with an influx of COVID-19 cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.

Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during COVID-19.5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home). …