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heart disease in a pandemic: 'by the time people come to hospital, they are very, very sick'

despite improvements in treatments, heart failure remains the second leading cause of death among canadians.

by karen hawthorne

feb 7 2022
read time 6 minute read
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heart disease: 'by the time people come to hospital, they are sick'
heart failure is an incurable condition that kills about 6,300 people each year. getty
unexpected weight gain, loss or change in appetite, bloating or feeling full all the time. swollen ankles, feet, legs or abdomen or lower back. extreme fatigue, increased urination at night. shortness of breath, especially when you’re lying flat.

heart failure has become one of the most prevalent and complex diseases in canada, but many canadians are unaware of the warning signs, and don’t know when they need help. falling under the larger umbrella of heart disease, which also includes coronary heart disease , heart failure happens when the heart muscle doesn’t pump blood as well as it should, either because the muscle is too weak, or stiff, or both. blood can back up and fluid can start filling the lungs which causes shortness of breath. it’s not the big heart attack that most people dread — in fact, once you have heart failure, it needs to be managed for the rest of your life.

“heart failure is a lifelong condition once you’ve been diagnosed,” says patrice lindsay , who started her career as a cardiac nurse, and is now the director of health systems change at the heart and stroke foundation of canada . “it has to be very carefully managed because not managing it puts you at risk of having it get worse. it’s really this rollercoaster of getting worse, then you get stabilized again until the next time it flares up.”

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anything that damages heart function can be a contributing factor, such as heart attack, high blood pressure, heart defects, diabetes, obesity, smoking, alcohol, stress. and with more people surviving heart attacks, an aging population, and as diabetes rates rise, heart failure rates will also increase.
early detection and lifestyle changes like regular exercise, healthy eating and staying connected with friends and family can make a difference, so creating awareness is a top priority for clinicians and advocacy groups, she says.
“if you’re having symptoms, it’s important to recognize the changes in your body and have it checked out,” says lindsay. “one of our biggest issues in the last couple years is that people have been hesitant to seek care and treatment because of the pandemic. but please don’t hesitate — don’t wait.”

hurdles to quality heart health care

to raise awareness of the dangers of delaying care, the foundation has released a report on heart failure that outlines the hurdles to quality care, sobering facts and figures, and a national action plan for improvement.

heart failure is an incurable condition that kills about 6,300 people each year, according to the report — 20 per cent more women than men — and is expected to cost canada more than $2.8 billion a year in health-care costs by 2030 as numbers of people diagnosed continue to rise.
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perhaps more concerning is that of the more than 100,000 canadians who are diagnosed each year, an increasing number are younger people.
“we’re seeing more heart failure in people in their 20s, 30s and 40s, which to some extent may be inherited, but to a lot of extent it’s lifestyle,” lindsay says of sedentary habits, poor eating and stress. “that’s worrisome.”
while acute cases see people with severe symptoms and unpredictable downturns, many people with heart disease have mild symptoms that can be well-managed with access to treatment, and live long, full lives. nonetheless, there are challenges, including depression and anxiety that can come with the uncertainty of a relapse.
paul gee knows this firsthand. the 54-year-old civil servant from regina, saskatchewan was diagnosed with heart failure in 2017 when he went to the er for shortness of breath and difficulty breathing. he thought he would be prescribed antibiotics for bronchitis or a respiratory infection and sent home. instead, he spent three days in hospital for tests and observation.
“the next day, a doctor walked into my room in the hospital, introduced himself and said, ‘i’m a cardiologist and you have congestive heart failure.’ i just broke down,” gee says of the news that came as a shock. he was fit, active and ate well, except for the occasional french fries with gravy or costco hotdog.

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while there was no cause identified for his heart failure, and he has no family history of the condition, gee says his diagnosis may have been related to the increasing stress he’d experienced in the past few years prior to the diagnosis. now on medication to manage his condition, he goes to a cardiac rehab centre for supervised exercise and counselling — but he hasn’t worked since his diagnosis.
“the mental health part is probably the biggest struggle that i’ve had,” he says. “i can ride a bicycle 20 minutes, i can do the weightlifting, but how long am i going to live for? anytime you’re feeling a little twinge in your chest or more tired than usual, you think, ‘is something happening?’”

pandemic delays

covid-19 presented its own set of challenges for people like gee who requires ongoing testing and monitoring.
“access to doctors was difficult, getting into the cardiologist, getting in for stress tests or blood work, echocardiograms or mris — all of the medical tests that come with having a chronic health condition where they want you coming in every three months or every month, that was all pushed back,” he says.
these are delays that can have devastating consequences.
dr. diego delgado, a lead cardiologist with the university health network in toronto, has seen cardiovascular complications related to covid-19 increase admissions to hospital, putting further strain on much-needed services for heart patients.

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“the delay in the access or concerns to come to the hospital from patients and families have made the situation worse,” he says, adding that the result has been more challenging cases. “sometimes when patients come to the hospital, they are very, very sick because they waited and didn’t come when the initial onset of symptoms occurred.”

virtual care has eased access

despite the turmoil that covid-19 has caused within the health care system, technology has been a tremendous benefit, says delgado, referring to remote, at-home monitoring equipment and wearable devices that can send information like blood pressure and heart rate directly and securely to a person’s health care team. virtual care has also helped patients access care in remote communities or places where certain specialists or therapies are not available.

he says he has seen major improvements in treatment, disease management and public health interventions in his 20 years of practice — including new drug therapies for patients that have improved survival rates, like sacubitril-valsartan  and sodium-glucose cotransporter-2 (sglt2) inhibitors for people with heart failure. there have also been advances in less invasive surgeries to help restore heart function and devices like the battery-powered implantable cardioverter defibrillator (icd) that goes under the skin to keep track of the heart rate, delivering an electric shock to prompt the heart to beat at a normal rate if it detects a dangerous rhythm.

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still, heart disease remains the second leading cause of death after cancer, and a leading cause of hospitalization, according to health canada — a trend that has a lot to do with poor lifestyle choices, says delgado.

“there are many reasons and when you look at lack of exercise and the way we eat, those will trigger more hypertension, diabetes and obesity,” he says. “these are the classic risk factors — and nine in 10 canadians have at least one cardiac risk factor.”
the best approach is always going to be prevention of heart disease, early detection, and specialized care.
“part of that is access to specialized care and improving the transition of care from teaching hospitals or university hospitals to the community to support patients and their families,” says delgado. “and if we’re able to identify patients earlier in the course of their disease, we can definitely have a significant impact in their outcomes for longer and better lives.”
karen hawthorne is a toronto-based writer.

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karen hawthorne
karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto as a freelancer, and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

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