COVID-19 Strikes Double Blow in Cardiomyopathy Patients

Liam Davenport

August 31, 2021

Cardiomyopathy patients are more likely to be hospitalised and have worse physical health as a result of COVID-19 than the general population, suggests a UK analysis that underlines the direct and indirect effects of the pandemic.

Initially comparing over 1200 cardiomyopathy patients with the UK population, the researchers found patients were no more likely to have a positive COVID-19 test but were more than three times more likely to be hospitalised with the infection and over five times more likely to be told to shield.

The team next looked at self-reported data on more than 200 cardiomyopathy patients and controls, which showed that, while no more likely to have COVID-19 symptoms, patients were more than twice as likely to experience physical deterioration during the pandemic.

Around a third of cardiomyopathy patients also reported missing clinical investigations or clinic appointments, while two fifths said their needs were not met by telemedicine.

The research was presented at the European Society of Cardiology Congress (ESC) 2021 on August 27.

Hospitalisation, Deterioration

"Patients with cardiomyopathy…were not at greater risk of testing positive for COVID-19 than the background population, but those with test-proven infection were hospitalised more frequently," said lead author Dr Daniel Hammersley.

"Subjective deterioration in physical health…could not be explained by COVID-19 symptoms, inferring a significant contribution of the indirect consequences of the pandemic."

Dr Hammersley, a clinical research fellow at the National Heart and Lung Institute, Imperial College, London, believes that their findings "have implications for both the health needs of these patients and the reorganisation of clinical services to meet these".

Marathon

This theme was taken up by Susanna Price, professor of practice in cardiology and intensive care at Royal Brompton Hospital, London, who was not involved in the study.

She told Medscape News UK that the response to the pandemic "was initially one of battlefield triage…and the reorganisation of healthcare services across the world responded in that way".

"We expected to be overwhelmed…but we’re now beginning to realise that this is not a sprint, this is a marathon."

She emphasised that COVID-19 "isn’t going to go away any time soon, so the way we are able to provide medical care, in particular for our cardiac patients…has to change".

Prof Price said this means "adjusting how we’re going to interface with our patients and keep them safe", something that is "vital" in this patient population.

Another problem is that people "massively reduced the amount of exercise they took, especially if they were told that they should be shielding at home".

"So they didn’t go out," Prof Price said, "they didn’t exercise, and we know that deconditioning has a significant effect on patient symptomatology."

Multifaceted, Challenging

Dr Hammersley noted that the "full impact of the COVID-19 pandemic on cardiovascular disease patients is multifaceted and challenging to measure in its entirety".

To determine the direct and indirect effects of the pandemic on patients with cardiomyopathy, they conducted two parallel analyses.

The first focused on patients with dilated cardiomyopathy and hypertrophic cardiomyopathy enrolled in the Royal Brompton and Harefield Hospital Cardiovascular Research Centre Biobank.

They collected primary care and hospital records and administered patient questionnaires to assess COVID-19 infections, hospitalisations, and shielding recommendations up to 2 November, 2020.

Of 1236 patients eligible for the analysis, 13 (1.1%) registered a positive test for COVID-19, which was non-significantly different from the rate of 1.6% (p=0.14) seen in official data on the UK general population over the same time frame.

Among the cardiomyopathy patients with proven COVID-19 infection, 53.8% required hospitalisation, compared with 16.5% of the UK general population (p=0.002).

Shielding was recommended to cardiomyopathy patients in 21.9% of cases, compared with 3.9% of the UK general population (p<0.001).

This is despite cardiomyopathy not being on the UK government’s pre-specified list of conditions that triggered a shielding recommendation, the researchers note.

There were no difference between patients advised to shield versus those not advised to do so in terms of their age (p=0.6) and sex (p=0.6).

However, patients advised to shield were significantly more likely to have New York Heart Association Class III or IV disease, indicating moderate to severe limitation of physical activity, at 22.2% versus 9.5% in those with better function (p<0.001).

Patients with dilated cardiomyopathy were also more likely to be advised to shield than those with hypertrophic cardiomyopathy, at 24.3% versus 18.8% (p=0.02).

Second Analysis

In the second analysis, the researchers conducted a prospective, observational study of participants in The Heart Hive online portal and registry, an initiative developed by investigators at Imperial College London and supported by Cardiomyopathy UK.

Participants completed online surveys adapted from the World Health Organisation’s survey tool for behavioural insights into COVID-19.

For the current analysis, 131 individuals with a self-reported diagnosis of cardiomyopathy and 76 with no known heart disease were included.

Cardiomyopathy patients were significantly more likely to report a deterioration in physical health due to the pandemic than controls, at 31.3% versus 13.2% (p=0.004).

However, only 4.6% of cardiomyopathy patients and 6.6% of controls reported experiencing COVID-19 symptoms, and none had confirmatory test results.

A high proportion (38.9%) of patients with cardiomyopathy missed clinical investigations during the pandemic, alongside which 29.0% had rescheduled clinic appointments and 16.0% had cancelled outpatient clinic appointments.

In addition, 7.6% had postponed or cancelled clinical procedures, and 5.3% missed medication doses.

It is also noteworthy that 40.4% of patients reported not having their needs met by telemedicine.

No funding declared.

No relevant financial relationships declared.

ESC Congress 2021: Abstract The direct and indirect effect of the COVID-19 pandemic on patients with cardiomyopathy. Presented 27 August.

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