Abstract
Résumé
Coronavirus disease (COVID-19): outbreak update. August 6, 2020. Ottawa, ON: Government of Canada; 2020.
Primary Impact of SARS-CoV-2 Infection on CV Risk

Impacts on CV morbidity or mortality | Direct effects of COVID-19 | Delayed/foregone health care | Social and economic impacts |
---|---|---|---|
Primary impact (days-weeks) |
|
| |
Secondary impact (weeks-months) |
|
| |
Tertiary impact (months-years) |
|
|
|
Secondary Effects Caused by Pandemic-Related Health Care Restrictions and the Infodemic
Shift from in-person outpatient visits to virtual care
Acute care avoided or delayed because of COVID-19–related fears
Curtailment of routine outpatient laboratory testing
Memorandum re: Cessation of Routine Laboratory & Fecal Immunochemical Testing During COVID-19 Pandemic. Edmonton, AB: Alberta Health Services; March 25, 2020.
COVID-19: Recommendations for the Public (#1-4); Recommendations for Clinicians (#5-9). 2020 Apr 30: Choosing Wisely Canada; 2020.
- Ellis E.G.
Drug shortages and 30-day prescription refill restrictions
Summary Report. www.drugshortagescanada.ca.
The Infodemic
NIH Halts Clinical Trial of Hydroxychloroquine (press release). Bethesda, MD: National Institutes of Health; 2020.
Tertiary Effects Caused by Pandemic-Related Social and Economic Restrictions
Loss of income and unemployment
Statistics Canada. Table 14-10-0287-03. In: Labour Force Characteristics by Province, Monthly, Seasonally Adjusted. Ottawa, ON: Statistics Canada; 2020. Available at: https://doi.org/10.25318/1410028701-eng. Accessed July 22, 2020.
Physical inactivity caused by stay-at-home orders
The Impact of Coronavirus on Global Activity. Fitbit News. March 23, 2020. San Francisco, CA: Fitbit Inc.; 2020.
Social isolation, depression, and anxiety
Moving Forward: Strategies to Mitigate Risk in the Era of COVID-19
Digital health interventions for the management of CV risk factors
Telehealth for management of BP
Telehealth for diabetes care
Conclusions
Acknowledgements
Funding Sources
Disclosures
References
- Coronavirus disease (COVID-19): outbreak update. August 6, 2020. Ottawa, ON: Government of Canada; 2020.(Available at:)https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.htmlDate accessed: October 29, 2020
- Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19).JAMA Cardiol. 2020; 5: 1265-1273
- Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic.J Am Coll Cardiol. 2020; 75: 2352-2371
- Immunothrombotic dysregulation in Covid-19 pneumonia is associated with respiratory failure and coagulopathy.Circulation. 2020; 142: 1176-1189
- COVID-19: ACE2-centric infective disease?.Hypertension. 2020; 76: 294-299
- Urgent need for evaluating agonists of angiotensin-(1-7)/Mas receptor axis for treating patients with COVID-19.Int J Infect Dis. 2020; 96: 348-351
- Can COVID 2019 disease induce a specific cardiovascular damage or it exacerbates pre-existing cardiovascular diseases?.Pathol Res Pract. 2020; 216: 153086
- Human recombinant soluble ACE2 in severe COVID-19.Lancet Respir Med. 2020; 8: 1154-1158
- Activation of Ang-(1-7)/Mas receptor is a possible strategy to treat coronavirus (SARS-CoV-2) infection.Front Physiol. 2020; 11: 730
- Potential effects of coronaviruses on the cardiovascular system: a review.JAMA Cardiol. 2020; 5: 831-840
- Cardiovascular implications of the COVID-19 pandemic: a global perspective.Can J Cardiol. 2020; 36: 1068-1080
- Microthrombi and ST-segment-elevation myocardial infarction in COVID-19.Circulation. 2020; 142: 804-809
- Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection.J Am Coll Cardiol. 2020; 76: 533-546
- COVID-19 cardiac injury: implications for long-term surveillance and outcomes in survivors.Heart Rhythm. 2020; 17: 1984-1990
- Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus.Diabetes Res Clin Pract. 2020; 164: 108166
- COVID-19 infection may cause ketosis and ketoacidosis.Diabetes Obes Metab. 2020; 22: 1935-1941
- New-onset diabetes in Covid-19.N Engl J Med. 2020; 383: 789-790
- Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic.Ann Intern Med. 2021; 174: 129-131
- Health system, public health, and economic implications of managing COVID-19 from a cardiovascular perspective.Eur Heart J. 2020; 41: 2516-2518
- Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US.JAMA Netw Open. 2020; 3e2021476
- Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data.BMJ. 2017; 356: j84
- The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.PLoS One. 2014; 9e115088
- The interplay between continuity of care, multimorbidity, and adverse events in patients with diabetes.Med Care. 2016; 54: 386-393
- Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality.BMJ Open. 2018; 8e021161
- Physical examination in the care of medical inpatients: an observational study.Lancet. 2003; 362: 1100-1105
- The physical examination as ritual: social sciences and embodiment in the context of the physical examination.Med Clin North Am. 2018; 102: 425-431
- Are You wearing your white coat? Telemedicine in the time of pandemic.JAMA. 2020; 324: 149-150
- Experiences of Health Care During COVID-19 Reported by Canadians. Toronto, ON: Canada Health Infoway; 2020.(Available at:)
- Impact of the COVID-19 pandemic on emergency department visits: United States, January 1, 2019-May 30, 2020.MMWR. 2020; 69: 699-704
- The untold toll: the pandemic's effects on patients without Covid-19.N Engl J Med. 2020; 382: 2368-2371
- Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US.JAMA Intern Med. 2020; 180: 1328-1333
- COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England.Lancet. 2020; 396: 381-389
- The Covid-19 pandemic and the incidence of acute myocardial infarction.N Engl J Med. 2020; 383: 691-693
- Reduced rate of hospital presentations for heart failure during the Covid-19 pandemic in Toronto, Canada.Can J Cardiol. 2020; 36: S74
- Admissions to Veterans Affairs hospitals for emergency conditions during the COVID-19 pandemic.JAMA. 2020; 324: 96-99
- COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.Eur Heart J. 2020; 32: 3045-3054
- Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study.Lancet Public Health. 2020; 5: e437-e443
- Decrease and delay in hospitalization for acute coronary syndromes during the 2020 SARS-CoV-2 pandemic.Can J Cardiol. 2020; 36: 1152-1155
- Case rates, treatment approaches, and outcomes in acute myocardial infarction during the coronavirus disease 2019 pandemic.JAMA Cardiol. 2020; 5: 1419-1424
- Impact of coronavirus disease 2019 (COVID-19) outbreak on st-segment-elevation myocardial infarction care in Hong Kong, China.Circ Cardiovasc Qual Outcomes. 2020; 13e006631
- The obstacle course of reperfusion for ST-segment- elevation myocardial infarction in the COVID-19 pandemic.Circulation. 2020; 141: 1951-1953
- Effect of the COVID-19 pandemic on ST-segment-elevation myocardial infarction presentations and in-hospital outcomes.Circ Cardiovasc Interv. 2020; 13e009438
- Break in the stroke chain of survival due to COVID-19.Stroke. 2020; 51: 2307-2314
- Cardiovascular collateral damages at the time of COVID-19.Can J Cardiol. 2020; 36: 1327-e1327
- Cardiovascular disease in the post-COVID-19 era: the impending tsunami?.Heart Lung Circ. 2020; 29: 809-811
- The impact of SARS on hospital performance.BMC Health Serv Res. 2008; 8: 228
- Memorandum re: Cessation of Routine Laboratory & Fecal Immunochemical Testing During COVID-19 Pandemic. Edmonton, AB: Alberta Health Services; March 25, 2020.(Available at:)http://www.albertahealthservices.ca/assets/info/ppih/if-ppih-apl-memo-physicians-cease-non-essential.pdfDate accessed: July 20, 2020
- COVID-19: Recommendations for the Public (#1-4); Recommendations for Clinicians (#5-9). 2020 Apr 30: Choosing Wisely Canada; 2020.(Available at:)http://www.choosingwiselycanada.org/covid-19/Date accessed: July 20, 2020
- What if you can’t avoid the hospital as Covid-19 spreads? San Francisco, CA: Wired, Conde Nast Publications; 2020.(Available at:)https://www.wired.com/story/coronavirus-covid-19-hospital-visits/Date accessed: August 10, 2020
- Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis.Eur Respir J. 2020; 55: 2000547
- The impact of drug shortages on patients with cardiovascular disease: causes, consequences, and a call to action.Am Heart J. 2016; 175: 130-141
- Summary Report. www.drugshortagescanada.ca.(July 16, 2020: Bell Canada; 2020. Available at:)https://www.drugshortagescanada.ca/rws-search?perform=1Date accessed: July 16, 2020
- Impact of the generic valsartan recall in Alberta, Canada.J Am Coll Cardiol. 2020; 75: 1860-1862
- Population impact of generic valsartan recall.Circulation. 2020; 141: 411-413
- Searching for adherence: can we fulfill the promise of evidence-based medicines?.J Am Coll Cardiol. 2016; 68: 802-804
- Safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension.Hypertension. 2017; 69: 927-932
- The risks associated with short-term placebo-controlled antihypertensive clinical trials: a descriptive meta-analysis.J Hum Hypertens. 2008; 22: 659-668
- Withdrawal of statins increases event rates in patients with acute coronary syndromes.Circulation. 2002; 105: 1446-1452
- UN tackles ‘infodemic’ of misinformation and cybercrime in COVID-19 crisis. United Nations, COVID-19 Response, March 31, 2020. New York, NY: United Nations; 2020.(Available at:)
- The parallel pandemic: medical misinformation and COVID-19: primum non nocere.J Gen Intern Med. 2020; 35: 2435-2436
- A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19.N Engl J Med. 2020; 383: 517-525
- NIH Halts Clinical Trial of Hydroxychloroquine (press release). Bethesda, MD: National Institutes of Health; 2020.(Available at:)https://www.nih.gov/news-events/news-releases/nih-halts-clinical-trial-hydroxychloroquineDate accessed: June 21, 2020
- Rapid scholarly dissemination and cardiovascular community engagement to combat the infodemic of the COVID-19 Pandemic.Can J Cardiol. 2020; 36 (969.e961-969.e962)
- Early in the epidemic: impact of preprints on global discourse about COVID-19 transmissibility.Lancet Glob Health. 2020; 8: e627-e630
- Pandemic publishing poses a new COVID-19 challenge.Nat Hum Behav. 2020; 4: 666-669
- The carnage of substandard research during the COVID-19 pandemic: a call for quality.J Med Ethics. 2020; 46: 803-807
- Characteristics and strength of evidence of COVID-19 studies registered on ClinicalTrials.gov.JAMA Intern Med. 2020; 180: 1398-1400
- Scope, quality, and inclusivity of clinical guidelines produced early in the Covid-19 pandemic: rapid review.BMJ. 2020; 369: m1936
Statistics Canada. Table 14-10-0287-03. In: Labour Force Characteristics by Province, Monthly, Seasonally Adjusted. Ottawa, ON: Statistics Canada; 2020. Available at: https://doi.org/10.25318/1410028701-eng. Accessed July 22, 2020.
- Living in the midst of fear: depressive symptomatology among US adults during the COVID-19 pandemic.Depress Anxiety. 2020; 37: 957-964
- The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey.CMAJ Open. 2018; 6: E63-70
- Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare.J Pharm Policy Pract. 2018; 11: 28
- Understanding the Gap: A Pan-Canadian Analysis of Prescription Drug Insurance Coverage.Conference Board of Canada, Ottawa, ON2017
- The effect of cost on adherence to prescription medications in Canada.CMAJ. 2012; 184: 297-302
- Low Earnings, Unfilled Prescriptions: Employer-Provided Health Benefit Coverage in Canada.Wellesley Institute, Toronto, ON2015
- Association of socio-economic status with diabetes prevalence and utilization of diabetes care services.BMC Health Serv Res. 2006; 6: 124
- Diabetes prevalence and income: results of the Canadian Community Health Survey.Health Policy. 2011; 99: 116-123
- The dynamics of the relationship between diabetes incidence and low income: longitudinal results from Canada's National Population Health Survey.Maturitas. 2012; 72: 229-235
- Socioeconomic status and hypertension: a meta-analysis.J Hypertens. 2015; 33: 221-229
- The association of unemployment with glucose metabolism: a systematic review and meta-analysis.Int J Public Health. 2018; 63: 435-446
- Psychosocial predictors of hypertension in men and women.Arch Intern Med. 2001; 161: 1341-1346
- Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals.Int Arch Occup Environ Health. 2015; 88: 707-716
- The cumulative effect of unemployment on risks for acute myocardial infarction.Arch Intern Med. 2012; 172: 1731-1737
- Socioeconomic status and cardiovascular outcomes: challenges and interventions.Circulation. 2018; 137: 2166-2178
- The Great Recession worsened blood pressure and blood glucose levels in American adults.Proc Natl Acad Sci USA. 2018; 115: 3296-3301
- Worldwide Effect of COVID-19 on physical activity: a descriptive study.Ann Intern Med. 2020; : 173
- The Impact of Coronavirus on Global Activity. Fitbit News. March 23, 2020. San Francisco, CA: Fitbit Inc.; 2020.(Available at:)https://blog.fitbit.com/covid-19-global-activity/Date accessed: July 16, 2020
- Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.Lancet. 2012; 380: 219-229
- Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease.Am J Physiol Heart Circ Physiol. 2020; 318: H1441-H1446
- Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.Int J Environ Res Public Health. 2020; 17: 1729
- The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public: a systematic review and meta-analysis.Psychiatry Res. 2020; 291: 113190
- Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: clinical implications for US young adult mental health.Psychiatry Res. 2020; 290: 113172
- Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom.Psychiatry Res. 2020; 291: 113267
- Psychosocial impact of COVID-19.Diabetes Metab Syndr. 2020; 14: 779-788
- COVID-19 pandemic and mental health consequences: systematic review of the current evidence.Brain Behav Immun. 2020; 89: 531-542
- Loneliness and social isolation as risk factors for mortality: a meta-analytic review.Perspect Psychol Sci. 2015; 10: 227-237
- Type 2 diabetes does not increase risk of depression.CMAJ. 2006; 175: 42-46
- Depression and risk for diabetes: a meta-analysis.Can J Diabetes. 2015; 39: 266-272
- Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis.Diabet Med. 2018; 35: 677-693
- Depression and anxiety screens as simultaneous predictors of 10-year incidence of diabetes mellitus in older adults in primary care.J Am Geriatr Soc. 2017; 65: 294-300
- Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes.Curr Diabetes Rev. 2005; 1: 235-243
- Symptoms of anxiety and depression in type 2 diabetes: associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study.Psychoneuroendocrinology. 2017; 84: 116-123
- Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife.Diabetes Care. 2004; 27: 2856-2862
- Depression in type 2 diabetes mellitus: prevalence, impact, and treatment.Drugs. 2015; 75: 577-587
- Prevalence of depression in patients with hypertension: a systematic review and meta-analysis.Medicine (Baltimore). 2015; 94: e1317
- Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies.J Hypertens. 2012; 30: 842-851
- Anxiety and hypertension: is there a link? A literature review of the comorbidity relationship between anxiety and hypertension.Curr Hypertens Rep. 2019; 21: 66
- The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults.Gen Hosp Psychiatry. 2008; 30: 127-137
- Adherence to medication, physical activity and diet in older adults with diabetes: its association with cognition, anxiety and depression.J Clin Med Res. 2019; 11: 583-592
- The association of depression with adherence to antihypertensive medications: a systematic review.J Hypertens. 2010; 28: 1785-1795
- Depression and its relation with uncontrolled hypertension and increased cardiovascular risk.Curr Hypertens Rev. 2014; 10: 8-13
- Impact of depression and anxiety disorders on adherence to oral hypoglycemics in older adults with diabetes mellitus in Canada.Eur J Ageing. 2017; 14: 111-121
- State of the art review: depression, stress, anxiety, and cardiovascular disease.Am J Hypertens. 2015; 28: 1295-1302
- Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: a scientific statement from the American Society for Preventive Cardiology.Am J Prev Cardiol. 2020; 1: 100009
- Automated hovering in health care: watching over the 5000 hours.N Engl J Med. 2012; 367: 1-3
- Mobile phone-based interventions for smoking cessation.Cochrane Database Syst Rev. 2016; 4: CD006611
- Increasing physical activity with mobile devices: a meta-analysis.J Med Internet Res. 2012; 14: e161
- Mobile phone interventions to increase physical activity and reduce weight: a systematic review.J Cardiovasc Nurs. 2013; 28: 320-329
- Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis.Mayo Clin Proc. 2015; 90: 469-480
- Interactive telemedicine: effects on professional practice and health care outcomes.Cochrane Database Syst Rev. 2015; 9: CD002098
- Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial.JAMA. 2015; 314: 1255-1263
- A digital health intervention to lower cardiovascular risk: a randomized clinical trial.JAMA Cardiol. 2016; 1: 601-606
- Telehealth for patients at high risk of cardiovascular disease: pragmatic randomised controlled trial.BMJ. 2016; 353: i2647
- Electronic patient-generated health data to facilitate prevention and health promotion: a scoping review protocol.BMJ Open. 2018; 8e021245
- Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis.Hypertension. 2011; 57: 29-38
- Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis.Ann Intern Med. 2013; 159: 185-194
- Unreliability of home blood pressure measurement and the effect of a patient-oriented intervention.Can J Cardiol. 2015; 31: 658-663
- Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis.PLoS Med. 2017; 14e1002389
- Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies.J Hypertens. 2013; 31: 455-467
- Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis.J Hypertens. 2016; 34: 600-612
- Cost-effectiveness of telemonitoring and self-monitoring of blood pressure for antihypertensive titration in primary care (TASMINH4).Hypertension. 2019; 73: 1231-1239
- Evaluating barriers to adopting telemedicine worldwide: a systematic review.J Telemed Telecare. 2018; 24: 4-12
- Evaluation of the clinical outcomes of telehealth for managing diabetes: a PRISMA-compliant meta-analysis.Medicine (Baltimore). 2018; 97e12962
- Telemonitoring in diabetes: evolution of concepts and technologies, with a focus on results of the more recent studies.J Med Life. 2019; 12: 203-214
- Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials.CMAJ. 2017; 189: E341-E364
- Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials.Diabetes Res Clin Pract. 2016; 116: 136-148
- Telehealth for diabetes self-management in primary healthcare: a systematic review and meta-analysis.J Telemed Telecare. 2018; 24: 356-364
- The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials.BMC Health Serv Res. 2018; 18: 495
- Using telecare for diabetic patients: a mixed systematic review.Health Policy Technol. 2014; 3: 90-112
- Organization of diabetes care.Can J Diabetes. 2018; 42: S27-35
- The COVID-19 pandemic: a "tech"-tonic shift toward virtual diabetes care.J Diabetes Sci Technol. 2020; 14: 708-709
Article Info
Publication History
Footnotes
See page 728 for disclosure information.