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Uncertain evolution of untreated coronary syndromes during covid-19 pandemic

Hayek and colleagues found that cardiac arrest is common and associated with poor survival in patients critically ill with covid-19.1 The sharpdecline in admissions for coronary syndromesduring the covid-19pandemic is a complex, prevalent, and maybe ominous phenomenon. We are seeing a lower rate of presentations and a higher rate of delayed presentationsof coronary syndromes.2 There arediverse reasons: patientsmightunderestimate the seriousness of their symptoms and seek medical attention later than usual, but also many cardiac and emergency units were restructured due to widespread covid-19 infection, becoming less functional.3 Although the excess death rate from untreated coronary syndromes is difficult to quantify, it is likely to be substantial.4 A drop in admissions for coronary syndromes is a risk factor for increased in-hospital cardiac arrest in the covid-19 pandemic (as Hayek and colleagues present1) as well as out-of-hospital mortality3 and morbidity, leading to a predictably higher rate of heart failure in a “third wave” of this pandemic. Primary care can play a critical role by encouraging patients with symptoms compatible with coronary syndromes—infected with SARS-CoV-2 or not—to proceed urgently to receive treatment.