The COVID-19 pandemic has disrupted many aspects of healthcare, but two leaders in the cardiovascular field believe lessons learned over the last year can help the U.S. deal with a future ‘tsunami’ of chronic health conditions, both those caused by the virus and from other causes.
Even before the pandemic, the U.S. has seen a downturn in life expectancy over the last few years. “This reversal is chiefly due to increases in drug overdose and suicide, but deaths from cardiovascular disease, particularly stroke, have also increased,” writes Robert Califf, M.D., in the journal Circulation. Califf is the head of clinical policy and strategy at Verily Life Sciences and Google Health, formerly a senior figure in health data science at Duke University School of Medicine and a previous commissioner at the FDA.
Currently cardiovascular disease, stroke and type 2 diabetes are three of the top 10 causes of death in the U.S. and this looks set to continue. Califf predicts that chronic cardiovascular and cardiometabolic conditions will rise exponentially. This is partly due to a continuation of this earlier problem and partly as a result of the pandemic and patients with chronic ‘long COVID’ symptoms, as well as those who have failed to seek proper care for cardiometabolic conditions or preconditions due to infection anxiety.
But he thinks that lessons learned from the last year could help to stem the flood of chronic disease if implemented soon enough. “While the pandemic has created additional impetus that unless heeded will amplify the consequences of this burden, the rapid adaptations and innovations in care and research prompted by the urgent response to it may also offer us the means to stem this flood,” he writes.
Nanette Wenger, M.D., a professor at Emory University School of Medicine, agrees with this in another Circulation article published at the same time as Califf’s that she co-authored with Sandra Lewis, M.D., Legacy Medical Group Cardiology.
Wenger is founding consultant to the Emory Women’s Heart Center and director of the Cardiac Clinics and Ambulatory Electrocardiographic Laboratory at Grady Memorial Hospital in Atlanta. In her article she says the U.S. is in fact dealing with three pandemics “COVID-19, economic disruption, and social injustice.”
“Although the magnitude of destruction will be forever sealed into our collective memories, we also have an opportunity to adapt in ways that are ultimately beneficial,” she writes. Although she emphasizes that changes need to be made to U.S. healthcare to give more equal access across the population.
Both experts think digital healthcare has a lot to offer patients with chronic conditions. This has expanded beyond all recognition during the pandemic and a continuation of at least some aspects of this – for example, telemedicine appointments, could be very beneficial for patients with chronic conditions.
“Wider uptake of digital technologies offers both risks and potential solutions. The influence of health-related misinformation has been particularly acute during the current crisis,” comments Califf in his article.
“But ubiquitous cell phones plus universal access to broadband internet could dramatically increase access to reliable medical information, digital support, and interactions between patients and clinicians over digital media, thus freeing up clinicians, especially nurses and community health workers, to function at the top of their capabilities and extend high-quality care into every community.”
Both experts note that care needs to be taken not to lose some communities in the uptake of digital medicine either through lack of resources, or factors such as limited internet provision in some rural areas.
Wenger notes that digitization also helped researchers and clinicians to access new information through online educational meetings and seminars. “Although the energy of in-person sharing of ideas disappeared, ease of joining meetings brought diverse, expanded audience opportunities and will be sustained in hybrid models going forward.”
Califf emphasizes that more of a focus is needed on prevention and looking at the big, overall picture to actively reduce chronic cardiovascular conditions and also to help manage the problem better.
“We need policies that combine improved individual care with structural changes that prioritize overall health in populations. These policies should be grounded in empirical evidence produced by the evolving discipline of implementation science,” he writes.
Currently the U.S. system incentivizes ‘rescue’ treatment for acute conditions or events, but does not welcome preventative, early interventions, many of which are available and can effectively stave off chronic conditions, at least for some time. This needs to change, according to Califf.
Califf and Wenger comment on the use of data tracking dashboards for monitoring COVID-19 patients, deaths, vaccines and the like. They suggest these could also be set up and used to help reduce the incidence and improve treatment for patients with chronic conditions.
“There is no fundamental technical impediment to making similar information about other diseases available in close to real-time to inform targeted policies and interventions at scales ranging from national to neighborhood,” says Califf. “The data are available, but an upfit in digital public health infrastructure is needed to enable access to reliable, granular data for planning and measuring the impact of interventions.”
Another important factor addressed in the two articles is how clinical research is conducted. There have been huge achievements in medical progress around COVID-19 this year, for example, with vaccines being developed in record time. However, this was only possible due to novel clinical trial approaches and co-operation from regulatory authorities.
The speed and enthusiasm with which the trials were conducted were not always been beneficial. “While ‘big data’ informed hope for rapid changes, pressure on renowned journals to publish these data presented tradeoffs between speed and safety, and resulted, in a few instances, publication of fabricated data,” cautions Wenger.
But there is no doubt that there are some aspects of these trials, such as the efficiency with which they were conducted, that could be emulated in the future to hopefully benefit patients and clinicians alike.
“The amazingly rapid generation of evidence for COVID vaccine development through the Operation Warp Speed public-private partnership should provide a template for ‘Operation Warp Evidence,’ with priority given to the most important clinical trials that assess risks and benefits of new therapies and directly compare available therapies,” concludes Califf.
Wenger adds: “The convergence of all of these issues, their impact on cardiovascular disease and care, presents unique opportunities for transformation in cardiovascular medicine, clinical care and research. We must remain focused and flexible during this unprecedented time to maximize innovation and achieve equity for all.”