Coronavirus and Cardiac Patients

Decline in cardiac patients seeking urgent medical care during COVID-19 pandemic

27 April 2020

There's been an alarming drop in the number of heart attack sufferers presenting for urgent medical assistance amidst growing fears of contracting COVID-19 at hospitals and doctors surgeries. In this video, Cardiologists Bob Graham and Jason Kovacic provide important advice for those most at risk.

Update 25 Nov 2021: Information from this article was accurate at the time of publishing and reflected the rules/advice announced by governing bodies at that time.

Video Transcript

Professor Jason Kovacic: Hi, I'm with Professor Robert Graham, Cardiologist from the Victor Chang Cardiac Research Institute. I'm Professor Jason Kovacic, Executive Director of the Institute. We want to talk to you today about COVID-19 and some of the issues that are arising from that. Bob, let me start off by asking you. We've seen a lot of changes in the way patients are coming to the department, coming into the emergency room. What's been your perception on what's happening? I heard that we’re seeing less people coming to the ER because they stay at home scared of the hospital.

Professor Bob Graham: Well, certainly that's happening in other countries in a big way. Up to 40% of the people in the United States are not coming in to see doctors when they should be coming in. They're leaving their illness until it is very advanced and they're obviously getting into trouble. Heart disease is often a chronic condition that needs to be looked at by your doctor on a regular basis and if you don't have that done then your medications can’t be monitored and you can get real problems. So I would urge people to continue to at least contact their doctor and make sure they at least have a telehealth consult. Jason I'll let you explain to people what that is, but it's very important that patients keep up their visits to their doctor and continue to get their treatments adjusted appropriately.

Professor Jason Kovacic: Right. It's a great point. So I've just come back from 11 years in New York City where I actually still see some patients at Mount Sinai Hospital. Telehealth has really exploded in the COVID-19 era. What it is, is basically a Skyping or Zooming or doing some other sort of video meeting in conference with a patient in the place of what would normally be a clinic consult visit. So a lot of the information can still be gathered by your doctor through a tele conference. Obviously one of the limitations is there isn't a physical examination, but even without that, most of the consult can still be effectively done by telehealth, by connecting with your doctors. So certainly it is a safe way of doing things if there is a lot of virus and a lot of infection going around and it keeps both your doctor and you protected from any possible transmissions, and it can keep you off public transport in some cases. So Bob, back to these patients, who needs to be careful specifically, which patients with different diseases need to be careful in this COVID-19 era, who's at risk?

Professor Bob Graham: Yeah, look, the people who are at risk are those obviously who are immunosuppressed, those who have had a heart transplant or any organ transplant. People with underlying heart disease where their heart function is not normal. That is, it's less than a hundred percent. People who've got diabetes. People who are overweight. Obesity seems to be a risk, a recently identified risk factor. It seems that if you get COVID with obesity, you're going to do worse. And one of the other things, Jason, is I know a lot of people are worried about coming in and having tests done if they need to go into a hospital or GP. What is your response to that?

Professor Jason Kovacic: Right. Especially now that the number of infected people with COVID-19 in Australia is so low, people really don't need to be concerned about coming into the hospital. In fact, we really encourage people to come in because patients would have been away from their healthcare providers for a good number of weeks now.

The hospital systems are very well set up to triage people and point them in the right direction as to whether they've got COVID or whether they come in for their routine tests. So really the risk of getting an infection of COVID if you're coming into hospital to have a test is extremely low. People really need to be taking care of their other longstanding health issues at this time. So Bob, let me ask you, one of the things coming through COVID-19 is a possibility of treatments and therapies and one of those aspects is a vaccine. Where do you think we stand with the vaccine?

Professor Bob Graham: Look, I think, I hate to be a pessimist because one hopes that the vaccine is the way forward. It is the way forward if you get a good one, but I think all the indications at the moment are that it’s very difficult and it's going to take a long time. At least I would say at best 12 to 18 months. That's optimistic. We don't have a vaccine for any of the coronavirus family as of yet that's effective. So it's going to be a challenge. In terms of other treatments, lots of other treatments are being looked at. You've probably heard of one and I'll actually call up one of them, which can potentially cause heart problems. So it has to be used carefully. And that’s Hydroxy Chloroquine which is an anti-malarial drug. You've probably heard about that.

Professor Jason Kovacic: Yes. So that’s where the Victor Chang Cardiac Research Institute gets involved in a couple of initiatives against COVID-19 and one of those is looking at this drug Hydroxy Chloroquine. It is a form of immune suppressant drug. It's used in people with lupus and sarcoidosis and periodic various other conditions, but it potentially, at least in certain experiments has been shown to have some effect in suppressing the virus, but it really is unproven at this time. A lot of people are receiving it, but we at the Victor Chang Cardiac Research Institute are looking into seeing how it can affect the cardiac electrical system because it definitely can change the electrical pattern in the heart, which can lead to the situation as Long QT Interval syndrome.

Professor Bob Graham: I think that's a really important issue, Jason, because while these heart problems may not occur very frequently, you can imagine if you've got hundreds of thousands of people on it, then you're going to get hundreds of styles in cases and side effects. So we have to be very careful.

Professor Jason Kovacic: Great point. Look one of the other interesting things I wanted to raise that we are doing at the Victor Chang Cardiac Research Institute is through stem cell therapy. We're investigating the possibility that, that might be helpful for patients with severe COVID-19 infections. Could you update us on that Bob?

Professor Bob Graham: Yes. It turns out there's a type of stem cell, which first of all it was very useful because you can give it from one patient to another. So we can take these stem cells from a healthy person and put it into someone who's got very severe respiratory disease due to COVID-19 and try and dampen down the hyper immune system activation these patients get. Now these cells, have a nice ability to try to be able to dampen down the immune system and we've now been able to give them to 10 people on compassionate grounds in New York who've had very severe COVID disease and were on a ventilator for respiratory disease and they seem to have done extremely well, but it's early days. That's an uncontrolled study and we need to look at it very formally and carefully to make sure they're safe and they use.

Professor Jason Kovacic: I've heard one of the interesting positives to come out of this is that while this is something we're hoping to dig into at the Institute we have actually got so few patients in the hospital system here, that we might not be able to get it going. Is that, is that reality?

Professor Bob Graham: Yes. That's reality. What a nice situation to be in.

Professor Jason Kovacic: It's great. So one of the final key points I think we need to touch on is what symptoms people need to be careful of. If you seem breathless, do you need to come immediately to hospital or how do you work through that as a patient?

Professor Bob Graham: Yeah. Look, I think if you're a heart disease patient, you know you've got an underlying heart disease and if you start to get breathless, you certainly should consult your Cardiologist. If that's not something you normally have, especially if it's getting worse or you've had it for the first time. The other things that would make you think you have heart disease as opposed to COVID-19 is if you get breathlessness in the absence of a temperature and the absence of a cough or in the absence of muscle aches, which are all the symptoms you get from coronavirus. Or in the presence of chest pain, which one might be thinking you've got a heart disease called Bristol's breathlessness, then you certainly should consult the doctor and in either case, I think you shouldn't wait until things have got too far. It's easier to treat people when the disease is not that severe.

Professor Jason Kovacic: Right. Look, those are the main questions I wanted to address. Anything else from you Bob?

Professor Bob Graham: No. Look I just encourage patients not to be scared or worried about coming in. Chances of getting coronavirus are very, very small. We take extreme precautions and we're in this wonderful situation in Australia where we're better off than actually any country in the world, in the fewest number of cases worldwide and hopefully that continues.

Professor Jason Kovacic: Right. Well I'd encourage you to head to our website, we've got several videos up on our website at the moment. Please check them out. There's a lot of information there. There's also a Q and A, we've got on our website about COVID-19, please take a look, a lot of information there for you. Thanks for watching the video and we look forward to getting back to you again soon with more updates.

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Julia Timms
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j.timms@victorchang.edu.au
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