Does having heart disease put someone at a higher risk for COVID-19 and why?
Having heart disease, among other comorbidities (chronic medical conditions), does put you at a high risk for having higher severe COVID-19 and complications, including dying of it. Hypertension (high blood pressure) and coronary disease are specific heart diseases that can cause worse outcomes. Unfortunately, we are going to need a lot more time and research to figure out the why.
Are there specific heart conditions that would put someone at a greater risk than others?
Coronary disease and high blood pressure have been the most studied and the easiest to pinpoint in the research we have so far. We do think other heart conditions, such as chronic heart failure and congenital heart disease, will also play a role in how people recover and how severe their COVID-19 disease is.
The other thing to consider is people who have coronary disease and other heart problems usually have a whole cluster of diseases and comorbidities that cause problems on their own with COVID-19. So usually it can come along with diabetes, obesity, older age, etc. All of those on their own are increased risks for how severe your COVID-19 course will be. So when you start putting it together, usually people don’t have just one comorbidity at a time. The studies are showing that having just one of those things, like just being overweight, or having high blood pressure or being 65 years or older, is enough to put you in that high-risk category.
The other thing we’ve found with COVID is that we don’t have a good handle on who is going to be hit hard and who won’t be hit at all. There are people who are perfectly healthy who are having a severe course and ending up in the ICU, and there are people who have a lot of medical problems and they get through relatively unscathed. So this is another thing that we really need more research on to determine who is going to be higher risk overall.
The short-term effects have mostly been studied in people who are having complications with their heart related to COVID. Unfortunately, we are finding more and more that COVID is a cardiac disease as well as a lung disease. In addition to the lung problems associated with COVID, it also can directly infect your heart, liver and kidneys. It causes this big inflammation in your body. It can also increase and cause a clotting disease. So the short-term effects we’re seeing are things like heart attacks. Sometimes that’s because people already have coronary disease, and that’s putting extra stress on their body from being sick and not having enough oxygen, and that’s enough to trigger a heart attack. But we are also seeing people who don’t have coronary disease, and then their body starts clotting and that causes a heart attack.
The next big thing we’re seeing is inflammation of the heart that causes a lot of irritation. So we’ll see bad heart rhythms, sometimes the kind that we need to shock people out of. We are very commonly seeing very slow heart rates, where your heart is not pumping fast enough. This is something called myocarditis, when that heart gets really inflamed. When people are in the hospital, we’re finding that their heart can’t squeeze hard enough sometimes to pump blood around their body, so they start having very low blood pressure and they go into organ failure from their heart. Interestingly, some new studies are finding now that about 25% of people admitted to the hospital are having cardiac complications, so this is something we’re watching very closely.
COVID-19 hasn’t been around that long, so there is some speculation about what might happen in the long-term. One of the main things studies are finding is inflammation in the heart months after someone had COVID. In one study, 60% of those who were two to three months after their COVID diagnosis still had active inflammation. That’s the type of thing that can cause heart failure symptoms, irritability of the heart and a lot of issues with that. The concern, especially with this study, is that the people they were studying were not those patients who had been hospitalized because of COVID. The majority of people in the study had a very mild disease. They were sick at home, did not require oxygen and some of them were even asymptomatic. So we’re very concerned that we are going to see long-term effects of this myocarditis in the population going months and years forward.
The next question usually is, “What does myocarditis do long-term?” We have other viruses that cause myocarditis, not nearly as common as COVID, and sometimes people get those immediate complications, but most people that have a viral myocarditis end up recovering if you can get them through that active phase of it. So we’re hoping that all these cases with COVID, with four out of five people in this study that ended up with myocarditis after COVID, that their bodies are able to clean it up long-term and not have any permanent damage. The problem with inflammatory issues with the heart is that it starts laying down scar tissue. So anytime we have inflammation in the body, it lays down little bits of scar tissue. Once that’s there, it’s called remodeling of the heart and it’s not a good thing because it makes it where the heart can’t squeeze efficiently and gets tired out. That’s when people start getting an enlarged heart and sometimes can’t recover from that.
So we’re concerned long-term — at one year, five years, 10 years down the road — that we’re going to start seeing a higher increase in heart failure over time.
Unfortunately, there’s really not much you can do. Once you have COVID, most of our care is what we call supportive. We try to support your body, we give you oxygen if you need it, if you’re having problems with your heart rhythms, we give you medications if you’re sick from it. One of the better options overall for COVID if you’re infected and in the early phase, are the monoclonal antibodies. That’s pretty much the best option we have to prevent you from moving into that second phase of the disease, which is that heavy inflammatory phase where people really decompensate. But unfortunately right now, we don’t have much besides just prevention.
I’m going to sound like a broken record on this one, but it’s because it’s what works. The first one is all of our measures of social distancing — stay home if you don’t need to be out, don’t get together in large groups or even medium-sized groups and of course wear your mask. I really encourage you to stick with it because it’s really the best option we have right now. Having a mask on helps. We’re not going to pretend that it makes you absolutely bulletproof, but if everyone does that, it does help. Hanging with it a little bit longer is going to help us get out of this.
The second thing is vaccinations. It’s really important for people to get vaccinated. I get asked every single day by my patients who are going to have heart surgery, just had heart surgery, who have other lung conditions, “Should I get the vaccine?” The answer is yes, yes, yes. The studies that have been done took tens of thousands of people together. They had all of these medical conditions, it wasn’t just a small group of really healthy people. It took all comers and this is really who we want to protect the most, which is why these tiers are open to people with comorbidities. And again, you only have to have one to count, so if you’re 65 or older, that counts. If you are overweight, have hypertension or have heart disease, those things are going to qualify you for getting the vaccine.
The next thing people usually ask is, “Which one should I get?” That answer is whichever one you can get. Pfizer and Moderna are the same style of vaccine — they’re both very similar in how well they work and their side-effect profile. They’re both safe and work extremely well. When the Johnson and Johnson vaccine is approved, I would encourage that one as well. Even though you’re going to hear all these different statistics in the news, a lot of that is a numbers game that we’re talking about in these papers. We need to get our death rate down. We need to get our serious complications and hospitalizations down, and all of these vaccines can do that. So I would strongly encourage you to go for the vaccine. If you have questions, I completely understand. It’s new and it seemed like everything went really fast, so I would encourage you to ask questions and get your information from a good source so you feel comfortable getting the vaccine when it's your turn.
Specifically looking at your heart, another thing we’ve seen, which is a little bit different than COVID’s effect on your heart, is COVID’s effect on our patients who don’t have COVID. We are seeing people stay at home because they’re afraid of coming to the hospital because of COVID. We are seeing people right now come in when they’re having big heart attacks or things have kind of progressed to a more serious state when we get them, so they’re coming in sicker and we’re having a harder time taking care of their heart, even when they don’t have COVID. I would encourage you, if you are having problems, if you’re having chest pain or signs of heart failure, to still go to your doctor, still come in so we can take care of your heart. We will take care of your heart and we have COVID safety protocols in place. We have everything separate.
The American Heart Association has developed a campaign called Don’t Die of Doubt because people are doubting that they need to come in or that they’ll be safe if they do. This is nationwide, so I really encourage you to listen to your body, listen to your heart. If you’re having problems that are new, if your legs are swelling up, if you can’t lay down flat without having really bad shortness of breath or new chest pain, those are things you need to talk to your physician about to see if it needs to be checked out. Don't die of doubt just because you aren’t sure if it means something or if it doesn’t — we have ways to test it and figure it out. Worst case, we say you’re fine and you’re just recovering and we’re glad you’re doing great. If not, if there’s something that needs to be done, then we’ll take care of you.
UT Health Tyler is an accredited chest pain center, recognized for excellence in treating heart attack symptoms. For more information, visit UTHeathEastTexas.com/HeartMonth.
UT Health Tyler recognized with Blue Distinction® Centers+ Designation
Quality, cost-efficiency in bariatric surgery
From Staff Reports
UT Health Tyler has been recognized by Blue Cross Blue Shield of Texas with a Blue Distinction® Centers+ for Bariatric Surgery designation, as part of the Blue Distinction Specialty Care program. Blue Distinction Centers are nationally designated healthcare facilities that show a commitment to delivering high quality patient safety and better health outcomes, based on objective measures that were developed with input from the medical community and leading accreditation and quality organizations.
The Blue Distinction Centers for Bariatric Surgery program provides a full range of bariatric surgery care, including surgical care, post-operative care, outpatient follow-up care and patient education.
Bariatric surgeries are among the most common elective surgeries in the U.S. — with more than 252,000 bariatric surgeries performed in 2018 based on a report from the American Society of Metabolic and Bariatric Surgery. Furthermore, the Centers for Disease Control and Prevention estimates that nearly 42.7% of U.S. adults and 18.5% of youth are obese and are impacted by obesity-related health conditions. With obesity reaching epidemic levels among U.S. adults, a significant opportunity exists to improve quality care for bariatric surgeries within the national healthcare system.
UT Health Tyler has been recognized by Blue Cross Blue Shield of Texas for meeting the rigorous Blue Distinction Center quality selection criteria for bariatric surgery set by the Blue Distinction Specialty Care program.
“We are very pleased to receive this designation from Blue Cross Blue Shield of Texas,” said Dr. Hugh Babineau, bariatric surgeon at the UT Health Tyler Bariatric Center. “Recognizing our commitment to quality care in this way will help us make these important medical procedures accessible to more residents of East Texas and the surrounding communities."
The annual healthcare spend on obesity and obesity-related conditions is expected to rise by 2030, if the rate of obesity in the U.S. continues to climb. Bariatric surgery is the most effective treatment for severely obese patients because it allows for substantial, sustained weight loss, which leads to, improves or resolves obesity-related co-morbidities like type 2 diabetes. On average, healthcare costs were reduced by 29% within five years following bariatric surgery, due to the reduction or elimination of obesity-related conditions, based on findings by ASMBS.
To receive a Blue Distinction Centers+ for Bariatric Surgery designation, a healthcare facility must demonstrate success in meeting patient safety measures as well as bariatric specific quality measures, including complication and readmission rate for laparoscopic procedures in sleeve gastrectomy, gastric bypass and adjustable gastric band. All designated facilities must also be nationally accredited at both the facility and bariatric program-specific levels, as well as demonstrated cost-efficiency compared to its peers. Facilities designated as Blue Distinction Centers+ are on average 20% more cost efficient in an episode of care compared to other facilities.
Quality is key: only those healthcare facilities that first meet Blue Distinction’s nationally established, objective quality measures will be considered for designation as a Blue Distinction Center+.
Since 2006, the Blue Distinction Specialty Care program has helped patients find quality specialty care in the areas of bariatric surgery, cancer care, cardiac care, cellular immunotherapy, fertility care, gene therapy, knee and hip replacement, maternity care, spine surgery, substance use treatment and recovery, and transplants, while encouraging healthcare professionals to improve the care they deliver. Research shows that, compared to other healthcare facilities, those designated as Blue Distinction Centers demonstrate better quality and improved outcomes for patients.
For more information about the program and for a complete listing of designated facilities,
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About UT Health East Texas
UT Health East Texas provides care to thousands of patients each year through an extensive regional network that includes 10 hospitals, more than 50 clinics, the Olympic Plaza Tower, 13 regional rehabilitation facilities, two freestanding emergency centers, regional home health services covering 41 counties, an EMS fleet of more than 50 ambulances and four helicopters, and a comprehensive seven-trauma center care network, including the region’s only Level 1 trauma facility.
As a partner with The University of Texas System, UT Health East Texas is uniquely positioned to provide patients with access to leading-edge research and clinical therapies while training and educating the next generation of physicians and other health professionals. The nationally recognized UT System also includes UT MD Anderson Cancer Center in Houston, UT Southwestern Medical Center in Dallas, as well as three other major university medical centers located throughout the state.
About the Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for one in three Americans. BCBSA provides healthcare insights through The Health of America Report series and the national BCBS Health IndexSM. For more information on BCBSA and its member companies, please visit bcbs.com. We also encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out our blog.
About Blue Distinction Centers
Blue Distinction Centers met overall quality measures, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ also met cost measures that address consumers’ need for affordable healthcare. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for noncovered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. ### Blue Cross and Blue Shield of Texas, a Division of Healthcare Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association