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Heart Failure: the impact of lockdown

Although restrictions continue to ease across the UK, the pandemic continues to shape health systems across the world by changing the way people seek and access medical care. Sadly, the British Heart Foundation has warned that the backlog of people waiting for diagnosis and care and fewer patients seeking referrals will contribute to a “cardiovascular ticking timebomb for the future”, with a rise in heart-related deaths.

We spoke to Consultant Cardiologist Dr Sam Firoozi about the signs and symptoms of heart failure to look out for, how lifestyle changes during lockdown have impacted heart health and how to safely access care.

How has the pandemic changed the way you treat and see patients?

The pandemic has had a huge impact in the way we see, assess and diagnose patients. While face to face consultations are really necessary for some conditions such as aortic stenosis, most general cardiology appointments are still carried out using video or telephone consultation.

While such consultations offer benefits, they do have their limitations – the most obvious being that you cannot physically examine the patient. The success of these consultations also depend on a number of other factors. For example, if a patient is outdoors at the time of the call, they may rush through their medical history or the phone reception may hamper the call quality. The inability to perform a physical exam may also lead to excessive ordering of tests and investigations.

Have the types of patients you’ve been seeing changed?

We have certainly seen fewer patients attending with symptoms such as chest pain or breathlessness and instead presenting with more advanced symptoms and even heart attacks. We have also had patients who ignored acute events such as heart attacks, and therefore left untreated leading to subsequent heart failure. Sadly, in some cases patients have died at home before seeking help.

Unfortunately as patients come in with more advanced heart failure, they are more likely to need a higher risk procedure. This means that delays to seeking help can really have a knock on effect on the patient’s overall outcomes.

What symptoms should people not be ignoring?

Recent or worsening breathlessness as well as exertional chest pain or tightness should not be dismissed. Other symptoms such as blackouts or palpitations should also be investigated.

Symptoms of heart failure are similar for men and women and include breathlessness on activity, a drop in exercise capacity, waking up at night short of breath as well as swelling around the ankles. In coronary disease however, men tend to experience chest pain, while women tend to report atypical symptoms such as breathlessness. There is a misconception that heart disease is not common among women and unfortunately, as result, some women have suffered cardiac events since the index of suspicion has been low. This has been especially worse during the pandemic as people have become reluctant to come forward and have shied away from coming into hospital.

What about lockdown itself, has this had any impact on our heart health?

Some people have been living more sedentary lifestyles with poorer diet relying on food delivery services, with a negative impact on their heart and cardiovascular health. Lockdown has also had a huge impact on mental health and stress which have direct adverse effects on cardiovascular health. On the other hand, some individuals have had more time to exercise, spend time with family, avoid commuting and improve their health while living at home, so it really depends on the individual.

If patients are concerned about any symptoms, how can they safely access care with you?

Due to very careful and well planned care pathways and precautions around delivering a Covid-free environment at The Harley Street Clinic, the risks of not seeking help for cardiac conditions far outweigh the risk of attending our facilities for expert cardiac care.

I aim to run a one-stop service, during which I see and assess patients and arrange any relevant investigations such as diagnostic scans, ECG or blood tests on the same day if possible. Diagnostic tests results can be discussed during the same visit if possible. In some cases, diagnostics and treatments are combined on the same day, minimising the need for multiple trips to hospital. I aim to see patients face to face for this reason, but I am also happy to offer video consultations if preferred or more practical.

Once results become available, if necessary, a follow up consultation is offered to discuss the findings and plan further management and treatment.

More information about Dr Sam Firoozi

More information about The Harley Street Clinic’s Cardiac Department

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