After a pandemic, there can be “an enormous wave of deaths and disabilities” from chronic illness

“As soon as the acute phase of this crisis is over, we will face an enormous wave of deaths and disabilities from more common chronic diseases with cardiometabolic disorders at its height.” Robert M. Califf, MD, MACC, The former FDA commissioner and head of strategy and policy for Verily Life Sciences and Google Health wrote in a comment.

Chronic diseases, particularly cardiometabolic, will become more common as a result of the COVID-19 pandemic. The data was derived from Califf RM. Traffic. 2021; doi: 10.1161 / CIRCULATIONAHA.121.053461.

Nanette K. Wenger

In the other comment, Cardiology Today Editorial Board Member Nanette K. Wenger, MD, MACC, MACP, FAHA, FASPC, Professor Emeritus of Medicine (Cardiology) at Emory University School of Medicine, Advisor to Emory Heart and Vascular Center, and Founding Advisor to Emory Women’s Heart Center Sandra J. Lewis, BA, MD, The Legacy Medical Group cardiologist in Portland, Oregon wrote, “While the extent of destruction will forever be ingrained in our collective memories, we also have the opportunity to adapt in ways that are ultimately beneficial. How can this disruptive transformation be turned into sustainable positive change for cardiovascular medicine and patients? “

Structural changes required

Before the pandemic, the declines in CVD and stroke in the US began to reverse due to poor lifestyle habits, leading to an increase in conditions such as obesity, high blood pressure and glucose intolerance, Califf wrote.

“This worrying pattern is compounded by an alarming increase in deaths directly from COVID-19 along with rising frequent deaths from chronic diseases and drugs,” he wrote. “The net effect is a significant increase in the surplus death and a correspondingly large decrease in average life expectancy in the United States, possibly by up to three years.” This is likely to disproportionately affect people with low incomes, low levels of education and rural residence, he noted.

Improved lifestyle interventions, increased adherence to preventive medication, and more comprehensive health insurance will all help reduce chronic disease rates, he wrote.

However, Califf wrote: “Improving diet, exercise, and medication compliance, and reducing tobacco use and drug addiction require a base of personal information and knowledge and a willingness to change. However, these behaviors are modulated by social determinants of health. Individual-level interventions will have limited success if they are not combined with structural measures to reduce the inequalities that lead to deterioration in health statistics. … We need guidelines that combine improved individual care with structural changes that prioritize the general health of the population. These policies should be based on empirical evidence produced by the evolving discipline of implementation science. “

Information about COVID-19 has been closely followed across the country and there is no reason why it couldn’t be done in chronic diseases, Califf wrote.

“Smart use of carefully validated digital technology can relieve the human effort of focusing where it makes the most difference,” he wrote. “The fight against COVID-19 has given us an insight into what is possible. If we act now, we can significantly reduce the damage caused by the impending tsunami. “

“Unique opportunities”

Wenger and Lewis wrote that the pandemic disrupted numerous areas of cardiology, including academic education, professional meetings, clinical care, acute care and research.

The disturbances had negative and positive effects. For example, they found that telemedicine was an innovative way to continue patient care that was worsening barriers to care for populations such as non-English speakers, rural residents, the homeless and people who couldn’t afford the internet or a smartphone.

“The COVID-19 pandemic, its impact on cardiovascular medicine, the economy and social unrest offer unique opportunities for change in cardiovascular medicine, clinical care and research,” write Wenger and Lewis. “Registers set up to track ‘long COVID’ could track cardiovascular treatment outcomes. Virtual transformation tools could improve service delivery. Huge inequalities encourage advocacy and infrastructure growth; B. broadband access. Fundamental challenges to developing treatments for COVID, the decimation of the economy while isolating and limiting normal activities, and ingrained social injustices require both traditional incremental and transformative rapid changes in public health infrastructure to address the disruption of COVID-19 encounter cardiovascular care and heart health. “

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