Article Text

Download PDFPDF
Cardiovascular health and COVID-19: time to reinvent our systems and rethink our research priorities
  1. David A Watkins1,2
  1. 1 Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Department of Global Health, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr David A Watkins, Medicine, University of Washington, Seattle, WA 98195, USA; davidaw{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Global trends in cardiovascular health have reached a worrisome inflection point. Decades of innovation led to a slew of drugs, devices and programmes that translated into reduced mortality from cardiovascular diseases in many countries. Unfortunately, progress on cardiovascular mortality since 2010 has slowed; in some countries, it has even reversed.1 Compounding the problem, political actions on cardiovascular health have been inadequate, and health systems across many low-income and middle-income countries are woefully under-resourced to scale up basic cardiovascular services. These factors could increase global health inequalities in coming decades.2

COVID-19 threatens to derail progress on cardiovascular health even further

Cardiovascular practitioners are now under greater pressure to deliver the same or better care in the context of a pandemic. COVID-19 has hit cardiovascular care particularly hard: WHO surveys recently found that cardiovascular services have been partially or completely disrupted in nearly half of countries with community spread of COVID-19, raising the chance of increased cardiovascular mortality in these locations.3

Two studies published in this issue of Heart shed more light on the specific effects of COVID-19 on health systems in Brazil and the UK. Brant et al looked at cardiovascular mortality in six Brazilian capital cities.4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals.5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand: the restructuring of hospital services to cope with an influx of COVID-19 cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.

Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during COVID-19.5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home). …

View Full Text


  • Contributors DAW is solely responsible for all aspects of the submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

  • Healthcare delivery, economics and global health
    Simon Ball Amitava Banerjee Colin Berry Jonathan R Boyle Benjamin Bray William Bradlow Afzal Chaudhry Rikki Crawley John Danesh Alastair Denniston Florian Falter Jonine D Figueroa Christopher Hall Harry Hemingway Emily Jefferson Tom Johnson Graham King Kuan Ken Lee Paul McKean Suzanne Mason Nicholas L Mills Ewen Pearson Munir Pirmohamed Michael T C Poon Rouven Priedon Anoop Shah Reecha Sofat Jonathan A C Sterne Fiona E Strachan Cathie L M Sudlow Zsolt Szarka William Whiteley Michael Wyatt
  • Healthcare delivery, economics and global health
    Luisa Campos Caldeira Brant Bruno Ramos Nascimento Renato Azeredo Teixeira Marcelo Antônio Cartaxo Queiroga Lopes Deborah Carvalho Malta Glaucia Maria Moraes Oliveira Antonio Luiz Pinho Ribeiro