The campaign, which was launched during a recent webinar run by the WHF, emphasised that angina is a serious condition which can be difficult to recognise, and that vigilance is crucial in detecting it. Angina is a symptom of coronary heart disease – the greatest killer across the globe, with close to 18 million deaths in 2016 according to the World Health Organization.1 However, angina is still under-recognised and undertreated.2 One study revealed that 43% of patients who had experienced angina in the past month were under-recognised by doctors as having the condition.3 p208, 210
During the webinar, Prof. Roberto Ferrari, former Professor of Cardiology at the Santa Anna University Hospital of Ferrara (now Emeritus), Italy, emphasised that while COVID-19 remains top of mind, the world continues to experience an epidemic of cardiovascular disease – which is now exacerbated by the pandemic and fear of hospital infection with coronavirus.
During the webinar Prof Ferrari said that since the COVID-19 pandemic there have been fewer hospital admissions for acute and chronic coronary symptoms – in other words, angina. There has been a dramatic drop in hospital admissions for acute heart syndromes: by 38% in the USA, 52% in the UK, 35% in Spain, 42% in Italy and 43% in Japan.
Prof Ferrari said that patients with angina are not being referred to hospital, and the outside mortality is increasing alarmingly. The media has been emphasising the hospital risk of COVID-19 infection – and instead cardiovascular disease mortality has increased dramatically. He emphasised that healthcare practitioners must stress that people can come to hospital via emergency services if they have angina and that there is a need for speedy investigation and care for those with angina symptoms.
Prof. Ferrari believes that the world will likely only see the real impact of COVID-19 in 2 to 3 years, including the impact of resource restriction on urgent non-COVID conditions, and the impact of interrupted care on chronic conditions. He referred to his research on the worldwide impact of diseases from January to July 2020, showing that while there were 700 000 deaths due to COVID-19 in that period, there were 10.4 million deaths from cardiovascular disease and 5.2 million from cancer.4
Prof Ferrari called on doctors and the media to emphasise the safety of attending hospital, and the need for patients to continue to take and to improve their preventative and anti-angina therapy.
Further complicating the issue is the fact that angina presents and is reported in many different ways, according to Dr Blanche Cupido, President of the SA Heart Association. She says: “Patients of varying cultural backgrounds may describe their symptoms of angina in differing ways. Some say chest tightness, others say crushing chest pain; we therefore need to listen carefully to the language of the heart. Shortness of breath is also an important symptom. These symptoms must always be investigated more thoroughly, because all too often they are missed and underestimated.”
Dr Cupido says that women are especially disadvantaged when it comes to coronary heart disease and access to care. “No-one expects them to have it – but postmenopausal women are at higher risk than men of a similar age. For example, if we see a young or middle-aged female with chest pain, we tend to think gastric as opposed to cardiovascular. We need to listen to our patients and probe more carefully, to gain a clear indication of how many episodes of angina they have had, when they happened and how long they lasted. Do not underestimate this life-limiting condition.”
Dr Cupido describes angina as an ‘alarm bell’ which is sent to warn people. “People with angina must consult a doctor – and we must be alert to any indication that a patient may have angina. Not all chest pain is cardiac/angina, but it’s better to be safe than sorry and to investigate it further. The COVID-19 pandemic will go away, but cardiovascular disease will continue to be the leading cause of death globally. This deadly condition should be faced with more seriousness to hopefully achieve more successful treatment outcomes.”
For more information, visit: https://www.world-heart-federation.org/
- World Health Organization. Total NCD Mortality (who.int) The Global Health Observatory. [6 May 2021].
- Busko M. Angina often missed, undertreated in stable CAD outpatients. Medscape – Mar 02, 2016.
- Qintar M et al. Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease. Eur Heart J Qual Care Clin Outcomes. 2016; 2(3): 208-214.
- R Ferrari. Corona or coronary? Eur Heart J 2021; 42(6): 555-557.