‘Enormous wave of death and disability’ from chronic diseases may come after pandemic
Chronic diseases, especially cardiometabolic ones, will become more prevalent as a result of the COVID-19 pandemic, according to two commentaries published in Circulation.
“Once the acute phase of this crisis is past, we will face an enormous wave of death and disability due to common chronic diseases, with cardiometabolic diseases at the crest,” Robert M. Califf, MD, MACC, former FDA commissioner and head of strategy and policy for Verily Life Sciences and Google Health, wrote in one commentary.
In the other commentary, Cardiology Today Editorial Board Member Nanette K. Wenger, MD, MACC, MACP, FAHA, FASPC, emeritus professor of medicine (cardiology) at Emory University School of Medicine, consultant at Emory Heart and Vascular Center and founding consultant at Emory Women’s Heart Center, and Sandra J. Lewis, BA, MD, cardiologist at Legacy Medical Group in Portland, Oregon, wrote: “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. How can this disruptive transformation be translated into sustained positive change for cardiovascular medicine and patients?”
Structural changes needed
Before the pandemic, U.S. declines in CVD and stroke mortality had started to reverse due obesity, hypertension and glucose intolerance driven by poor diet and lack of exercise, Califf wrote.
“This concerning pattern is compounded by an alarming increase in deaths directly from COVID-19 together with rising common chronic disease- and drug-related deaths,” he wrote. “The net effect is a substantial increase in excess death and a correspondingly steep drop in average U.S. life expectancy, perhaps by as much as 3 years.” This is likely to disproportionately affect people with low incomes, low education levels and rural residence, he noted.
Improved lifestyle measures, increased adherence to preventive medications and more comprehensive health care coverage will help reduce the rate of chronic diseases, he wrote.
However, Califf wrote: “Improving diet, exercise and medication adherence and reducing tobacco use and drug addiction require a base of personal information and knowledge coupled with readiness to change, but these behaviors are modulated by social determinants of health. Individual-level interventions will have limited success unless they are coupled with structural measures to reduce the inequities driving deteriorating health statistics. ... 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.”
Information about COVID-19 has been tracked closely throughout the country, and there is no reason the same could not be done for chronic diseases, Califf wrote.
“Intelligent deployment of carefully vetted digital technologies can free up human effort to be focused where it makes the greatest difference,” he wrote. “The fight against COVID-19 has given us a glimpse of what is possible. If we act now, we can significantly reduce the damage from the impending tsunami.”
Wenger and Lewis wrote that the pandemic disrupted numerous areas in cardiology, including academic training, professional meetings, clinical care, acute care and research.
The disruptions had negative and positive implications, they wrote, noting, for example, that telemedicine represented an innovative way to continue the care of patients but worsened the barriers to care in populations such as non-English speakers, rural residents, the homeless and people who could not afford the internet or a smartphone.
“The COVID-19 pandemic, its impact on cardiovascular medicine, the economy and social unrest converge to present unique opportunities for change in cardiovascular medicine, clinical care and research,” Wenger and Lewis wrote. “Registries established to track ‘long COVID’ could track cardiovascular treatment outcomes. Virtual transformational tools could enhance care delivery. Vast inequities spur advocacy and infrastructure growth, eg, broadband access. Fundamental challenges to development of treatments for COVID, decimation of the economy while isolating and limiting normal activities, and deeply rooted social injustices laid bare, will require both traditional incremental and transformative rapid change in public health infrastructure to confront the disruption of COVID-19 on cardiovascular care and heart health.”