New research led by Heart & Stroke published in CJC Open shows that in countries like Canada with accessible health care and a higher proportion of people living with heart conditions and stroke, the COVID-19 death rate is higher than in countries with fewer healthcare services. The study also reveals the serious disruption to essential health care for people living with cardiovascular disease, with more than 1,200 medical procedures being postponed each month in Ontario alone due to the impact of the pandemic.
“The higher death rate due to COVID-19 in countries such as Canada is surprising. This is partly because more people in countries with greater availability of essential healthcare services survive heart conditions and stroke,” says Dr. Cindy Yip, Director, Data Knowledge Management and Heart Program, Heart & Stroke and principal investigator of the study. “This means more people are actually living with these conditions longer and this puts them at greater risk of dying from COVID-19.”
In fact, for every 1% increase in the size of a country’s population with heart conditions or stroke, the death rate from COVID-19 was 19% higher. Older age also puts people at greater risk of dying from COVID-19: for every 1% increase in the size of a country’s population of people 65 years and older, the death rate from COVID-19 was 9% higher.
An estimated 297 coronary artery bypass graft (CABG) procedures, 703 percutaneous coronary interventions (PCI or angioplasty with stent) and 252 valve surgeries for a total of 1,252 procedures are being postponed per month in Ontario due to COVID-19.
“The number of procedures for people living with heart conditions or stroke that have been postponed during the pandemic is significant,” says Dr. Sharon Mulvagh, cardiologist and professor at Dalhousie University and a co-author of the study. “The repercussions from these delays will impact the health of people living with these conditions. Now as the first wave of the pandemic is subsiding and we are gradually reopening services, we are witnessing that the associated backlog is creating real challenges as the healthcare system begins to increase towards full capacity. However, the good news is that we are learning a lot of lessons about adjusting delivery of services in the event that subsequent waves occur.”
The study also identified that countries with higher rates of COVID-19 testing have lower death rates from the virus. For every 1% increase in testing for COVID-19, deaths from COVID-19 decrease 4%. This could be due to a larger overall number of COVID-19 cases identified, resulting in a lower overall death rate, as well as providing more information about active cases.
“The more you test, the more lives you save,” says Dr. Patrice Lindsay, Director, Systems Change and Stroke Program, Heart & Stroke and a co-author of the study. “Higher rates of testing increase the likelihood of identifying milder cases, allowing for the disease to be caught earlier, and potentially reducing the severity of those infected and the spread of the disease.”
Although many procedures have been postponed due to COVID-19, anyone living with a heart condition or stroke who experiences a change or worsening in symptoms should seek medical attention – even during a pandemic. Not getting timely treatment for ongoing chronic conditions could result in patients becoming critically ill or worse and an even greater eventual impact on the healthcare system. Read the study.
The study notes 11.7 percent of Canadians suffer from cardiovascular disease, including strokes. That puts Canada in the top third among 63 countries studied — worse than the 11.6 percent found in the United States, 10 percent in Russia, 7.6 percent in South Korea, 4.3 percent in India and 3.8 percent in Pakistan.
When it came to reported death rates from COVID-19, Canada ranked higher than all but 14 of the 65 countries studied. That included places with poorer health-care resources such as Russia, India, Pakistan, and China.
The study concludes that this information may be of benefit to health care planners to guide reactive and proactive measures in the management of the COVID-19 pandemic in Canada, the planning for health system recovery, and triaging burgeoning wait lists.
If we look at the latest graph below from ourworldindata.org, it summarizes COVID-19 related deaths per million population and shows the contrast between the number of deaths compared between the UK, US, Canada, India and Pakistan.
Source: heartandstroke.ca | ourworldindata.org | File photo for illustrative purposes