Disruption to cardiac services during the COVID-19 pandemic has caused "global collateral damage" that may have lasting ramifications, according to a study published on May 31.

In the paper published in the European Heart Journal, the researchers warn that problems with heart health will "...continue to accrue unless mitigation strategies are speedily implemented".

In the two years from December 2019, when health systems around the world were under extreme pressure and people were fearful of catching COVID, individuals experiencing an acute cardiac event such as a heart attack or heart failure either stayed away or could not get admitted to a hospital.

The study, involving an international team of doctors and data scientists led by the University of Leeds, UK, describes a "substantial global decline" in hospital admissions of people suffering from cardiovascular disease. As a result, the number of people dying at home or in the community from heart conditions increased.

In cases where people did get medical help, there was, on average, more than an hour's delay in reaching the hospital or having contact with paramedics. The chances of people surviving a major heart attack depend on timely and appropriate treatment.

Although the problems identified by the researchers were seen across the world, they were exacerbated in low to middle-income countries, the researchers said. Hospitals and clinics in those locations struggled to give the gold standard treatment, in some cases using drugs instead of interventional procedures such as fitting a stent into a blocked artery.

The result has been an increased death rate among cardiovascular patients in hospitals in low to middle-income countries, as well as more people dying at home from cardiovascular disease.

The findings were based on data from 189 separate research papers looking at COVID'S impact on cardiovascular services from 48 countries on six continents and covering a two-year period from December 2019.

"Heart disease is the number one killer in most countries - and the analysis shows that during the pandemic people across the world did not receive the cardiac care they should have received," said Dr Ramesh Nadarajah, a British Heart Foundation Clinical Research Fellow at the University of Leeds.

"That will have ramifications. The longer people wait for treatment for a heart attack, the greater the damage to their heart muscle, causing complications that can be fatal or cause chronic ill health. Health systems need to reinforce systems to help support and treat people whose heart conditions will inevitably be worse because of the pandemic," Nadarajah said.

Earlier this month, the World Health Organisation (WHO) published estimates of the excess deaths associated with the COVID-19 pandemic, which would include people who were unable to access prevention and treatment for cardiovascular diseases due to overwhelmed health systems.

Between 2020 and 2021, the WHO calculated there were 14.9 million excess deaths globally. "The repercussions of the COVID-19 pandemic on cardiovascular care and outcomes will be with us for a long while yet," said Professor Chris Gale, Consultant Cardiologist at Leeds.

"There is little doubt that there will continue to be deaths and illnesses that would not have otherwise occurred. Urgent action is needed to address the burden of cardiovascular disease left in the wake of the pandemic," he added.