Cardiologist worries heart patients denying themselves care over pandemic fears

A St. John's cardiologist says public health restrictions put in place under the COVID-19 pandemic, while justified, may be harming cardiac patients whose procedures have been postponed indefinitely as well as heart patients who are avoiding hospitals.

The longer a patient waits for procedures like dye tests and cardiac surgery, says Dr. Sean Connors, the greater chance their condition will deteriorate.

"People who require tests and are relatively stable now, if you make them wait months on end, then they are more likely to have worse outcomes," he said.

Newfoundland and Labrador Health Minister John Haggie said Thursday that about 5,500 surgical procedures in the province have been postponed since the start of the pandemic.

Urgent heart surgeries are still being done but elective heart surgeries have been postponed. Cardiac surgery patients remain in hospital after their procedures, and health authorities are trying to keep beds free in case of a sudden surge of COVID-19 cases.

Connors, the clinical chief of cardiology at the Health Sciences Centre, said about 125 people are on a wait list for cardiac surgeries such as bypasses.

I do spend sleepless nights about this.- Sean Connors

Modelling done in Ontario estimated that by the end of April, 35 people waiting for heart surgeries in that province died because they didn't have their surgeries.

Connors says he doesn't believe there have been similar deaths in Newfoundland and Labrador — but it could happen.

"If you create a wait list of people who require surgery, some people will die unexpectedly," he said.

Patients staying home when they should go to hospital

Connors is also worried patients are staying away from health-care facilities, denying themselves the care they need, because of the novel coronavirus.

"I do spend sleepless nights about this," he said. "What I fear is that some of our patients haven't been coming to the emergency room with chest pains that they normally would because, to be frank, I think they're afraid because of the virus."

He's also concerned patients may have a unwarranted belief that they're a burden on a system stressed by COVID-19.

"I think there's a genuine concern in the patients out there in the community where they don't want to come into the hospitals because they feel that they would burden physicians because they perceive us as being overwhelmed by the virus," said Connors.

• Triaging surgeries, virtual care: N.L.'s health system is in pandemic mode
• How hospitals will tackle the backlog of nearly 100,000 surgeries delayed by the pandemic

For whatever reason, he said, cardiac patients have not been showing up. Emergency rooms are seeing patients with heart attacks at half the rate they normally do, he added.

"It's not that these things are not happening but rather these patients are having symptoms and not coming to get the medical attention that they need to have and it concerns me deeply."

I fear if people don't get things checked out bad things can happen.- Sean Connors

Connors says people need to know that if they have concerning symptoms, they can still get care.

"Please show up — we are still here to treat you, you can still have services, we are still running for the patients who need us," he said.

"I fear if people don't get things checked out, bad things can happen."

One heart patient's story

Jack Eastwood is one of about 125 patients waiting for heart treatment in Newfoundland and Labrador.

In October, he was told he needs bypass surgery because the arteries that supply blood to his heart are blocked.

It's considered elective surgery and Eastwood, 72, was scheduled to get it in April.

"But, of course, COVID has now put that on hold," said Eastwood, who added his health is good and he doesn't think it's deteriorated while he waits.

He said he understands why hospitals need to keep capacity available for COVID-19 patients.

The doctors have been very kind to me. They're stuck between a rock and a hard place at the moment and I'm under one of those rocks.- Jack Eastwood

"They've been prudent in making sure that if we do get some kind of a rush that they would be able to take care of COVID-19 patients," he said.

With the risk of serious illness because of the novel coronavirus being higher in patients with underlying conditions like heart disease, he also understands why patients would avoid health-care facilities.

"I'm thinking, what if I was there and I were exposed to the virus? I think my chances would be pretty slim. I certainly don't want to be in a place where I could be exposed to the virus because with my heart the way it is, if I became infected, I could be in trouble. So the COVID scares me," he said.

Eastwood weighs that against concerns that his condition might deteriorate.

"My blockage was 90 per cent back in the fall. I'm taking my medications and doing what I can, but it progresses as time goes on. So I'm a little worried about where I am. I want it done but I want it done in a situation where I can't be exposed to something fatal," he said.

"The doctors have been very kind to me. They are stuck between a rock and a hard place at the moment and I'm under one of those rocks," he said.

How much capacity is needed for COVID-19?

As of Thursday, in Newfoundland there were 10 COVID-19 patients recovering at home and four in hospital.

Connors says health professionals are carefully considering how many hospital beds need to be kept free for the pandemic.

"In the beginning, when we didn't know what would happen, we had to prepare for the worst. We may be criticized for overpreparing. As we move through this, then that whole risk-benefit analysis is starting to swing more toward that large group of people who are not having their disease or condition treated as quickly as normal," he said.

Eastern Health is discussing how to ramp up cautiously

"At Eastern Health, we are involved in discussions daily now about how do we slowly ramp up in a cautious fashion but still preserving capacity should see a surge in Covid in our community. As more through each week and see the covid requirement is not there , we would like to apply as much of the resource as we can spare to addressing those people that we have had to postpone over the last six or seven weeks."

Read more from CBC Newfoundland and Labrador