COVID-19 doesn’t just affect the lungs; it also has devastating and potentially long-term effects on the heart. Research shows that Covid-19 can either worsen underlying cardiovascular diseases (CVD) or precipitate de novo (new) cardiac complications.
Globally, there are about 1.7 billion people with at least one underlying health condition, including CVD. This escalates the risk of heart complications, cardiovascular events, and mortality among those infected.
Patients with underlying medical conditions, such as hypertension, diabetes mellitus, myocardial injury and heart failure, are known to have approximately five times higher risk of developing severe Covid-19 symptoms and higher mortality rate compared to those without prior CVD. Covid-19 patients also have high chances of developing cardiovascular complications after recovery.
About 87% of deaths from Covid-19 in Malaysia in 2020 had at least one underlying medical condition (61.4% with hypertension and 41.3% with diabetes). Hypertension is the most common complication reported.
While most patients might recover completely, few might continue to experience symptoms after their initial recovery – an aftermath of being very ill, prolonged inactivity and spending weeks convalescing in bed.
Fulminant myocarditis, a clinical condition of diffuse cardiac inflammation often leading to death, have been reported among a few recovered patients within weeks after discharge and normal viral load.
These issues put a heavy burden on the already congested health system in our country. Proactive health service is needed to ensure that patients with underlying non-communicable diseases (NCDs) as well as those at risk of post-Covid-19 cardiovascular complication are adequately cared for.
This will benefit both the population as well as the healthcare system by preventing unnecessary hospital admissions and cutting the cost of medical expenditure, too.
Below are some practical recommendations from the World Heart Federation to ensure that Covid-19 patients with either underlying or new onset cardiovascular complications have a better outcome:
1. Covid-19 patients should be managed based on the severity of their illness; those with moderate or severe symptoms should be admitted to a separate ward for closer monitoring.
2. Patients should be informed about the lingering symptoms and warning signs like fatigue, shortness of breath, cough, joint pain, palpitation and chest discomfort, and to seek immediate medical attention if these worsen.
3. High-risk patients upon discharge should have a repeat echocardiogram within three months and follow-up for a minimum period of six months at their local government clinic.
4. They should be encouraged to adopt healthy lifestyles (stop smoking, be physically active, consume a healthy and balanced diet) to reduce the risk of developing cardiovascular events that can make them vulnerable to severe symptoms of Covid-19. Patients recovering from Covid-19 can benefit from physical therapy and breathing exercise.
As our healthcare system is currently overburdened, the primary care service should be empowered to reach out to those who are vulnerable.
A proper triage system should also be established in the primary care setting to identify and refer those who are in need for further care immediately.
General practitioners and primary care doctors in government clinics should also be trained to monitor Covid-19 survivors with potential cardiac complications after discharge to ensure their quality of life is maintained. This should be a shared responsibility by both the healthcare system and the population.
The article was written by Dr Malar Velli Segarmurthy, Dr Kalaashini Ramachandran (Doctor of Public Health candidates), Professor Dr Moy Foong Ming and Professor Dr Noran Naqiah Hairi. It was first published on Free Malaysia Today, Code Blue, My SinChew and The Star.