How to build a better world for heart health after COVID-19

If cardiovascular disease (CVD) was already the biggest killer (accounting for an estimated 31% of all deaths worldwide) before the COVID-19 pandemic, then it has only gotten worse in 2020. With World Heart Day on 29 September, it's a timely moment to reflect on how single actions can solve multiple problems - a theme of the "great reset" underway in response to the pandemic.

Studies from China have shown that the fatality rate for COVID-19 patients with an underlying heart condition was over 10%, compared to around 7% for diabetes, 6% for patients with cancer and less than 1% for those with no underlying health issues. But these figures may actually be conservative. Early studies in Italy, for example, point to fatality rates as high as 35.8%, and the Indian Health Ministry has stated that 76% of COVID-19 deaths had comorbidities, with hypertension and heart disease prominently featured.

As if that wasn’t enough, both routine and emergency cardiovascular care have suffered during the pandemic. A survey of more than 3,000 health professionals from 141 countries shows declines from 25 to 40% in patients admitted to hospital for heart attacks. Fearful of being infected, many are staying away from hospital­ – with potentially fatal long-term consequences. Others are delaying calling an ambulance. Over half of those patients who did come to hospital did so too late for an effective emergency intervention.

“We’ve all read the headlines about the decrease in 9-1-1 calls suggesting that many people are not seeking care for medical emergencies like heart attacks or strokes,” said Nancy Brown, CEO of the American Heart Association. “This is of great concern because we know that heart attacks and strokes have not stopped.”

COVID-19 also seems to frequently result in heart damage (notably cardiac inflammation), even in previously healthy people. There is concern that even people who have mild cases of the virus may have lingering heart problems. This is leading doctors to worry that we will see an increase in patients with heart failure down the line.

Yet despite these challenges, there is also an opportunity. As we build back better, putting this issue at the centre of our planning will allow us to tackle multiple areas of concern –reaching way beyond heart health.

So how do we achieve that? Beginning with the obvious, we can call on governments to introduce heart-smart policies. Simple actions such as more effective taxation on tobacco could go a long way to improve not just heart health and public finances, but baseline fitness and wellbeing for the estimated one billion people who smoke across the world.

Taxation has been proven to be one of the most effective ways to reduce tobacco consumption. Yet currently, only one in five countries (representing just 13% of the world’s population) are implementing the World Health Organization’s recommended taxation levels.

The pandemic has also highlighted the cost of social inequality, with the poorest and most isolated suffering disproportionately. The World Heart Federation often talks about the importance of ‘heart equity’, the idea that one person’s heart is as important as another’s. We need to rebuild our health systems to reflect that simple idea – to provide universal health access and coverage. Imagine the impact this would have at a societal level.

“We know the virus profoundly impacts people with heart disease, but we also know that [in the US] it disproportionately impacts Black people and Latinos,” said Nancy Brown. “It has become increasingly clear that the stark disparities along racial and socioeconomic lines reveal how much work is to be done to improve public health.”

This sentiment is shared by Dorairaj Prabhakaran, Vice President of Research and Policy at the Public Health Foundation of India, who said, “we need to turn the world’s attention the low- and middle-income countries where most people live. There is an urgent need for prevention and health promotion, strengthening primary care and shoring up the health system overall. The necessity to protect heart health is more important than ever.”

Building heart-healthy workplaces is another area where we can have a huge, positive impact. The claim that "sitting is the new smoking" has been popular for some time. Certainly, a lack of basic exercise and movement is not only a contributory factor for CVD but a whole host of other health and biomechanical issues. Moreover, employees that regularly move and control their space are known to be more creative, more collaborative and more productive. COVID-19 has also highlighted the importance of indoor air quality from a health perspective, while the Harvard Business Review has done so from a business perspective. Research shows that workers in offices with better natural ventilation and biophilic design are significantly more productive, with lower blood pressure and heart rates.

Going further, the idea of a heart-healthy office should be scaled up to the city level. Bear in mind that more than half the world’s population currently lives in cities (up from 2% in 1800) and that is expected to rise to close to two thirds by 2050. Yet currently, air pollution causes 4.3 million deaths a year and contributes to around 25% of all deaths from heart disease. So this is a problem that needs to be urgently tackled. Accelerating the transition to electric vehicles, building cycling infrastructure and improving public transport would not only be good for the environment – it would be good for people too. So would more green spaces, installations, pedestrianised areas and any other planning techniques that make spaces fun, communal and easier to walk around. This could also go a long way to rebuilding our broken communities, with social isolation being a major factor not just in mental health, but heart health too.

Finally, as we start to make these changes at a systemic level, we need to understand more about behaviour change at an individual one and the factors that favour it. We all know a smoker that would like to stop. So, it isn’t necessarily a lack of knowledge that is the problem – it is figuring out how to actually change your behaviour. That’s why the World Heart Federation is hosting a panel series on Behavioural and Societal Change with leading experts from multiple disciplines so that we can gain new insights into how to approach this critical topic.

We need this kind of multi-disciplinary thinking to identify the most effective changes we can make. And we need a topic like heart health, that has the potential to massively improve so many lives to rally around. If we “use heart” to build back better, we can achieve so much more.