Are You Delaying Care Due to COVID Fears?

February 16, 2022

MercyOne North Iowa Cardiologist at the Mason City Clinic Urges You To See Your Doctor.

Board-certified cardiologist at MercyOne North Iowa Cardiology Care at the Mason City Clinic, Denisa Hagau, MD, and her colleagues are seeing a disturbing trend: people who have heart disease are delaying seeing their doctor out of fear of getting COVID.  Some wait too long to get the proper care they need to manage their heart condition.

Listen to Dr. Hagau discuss the problems they are seeing, what the risks are, the COVID safety precautions that are in place and how to ensure that you and your loved ones stay well and avoid unnecessary, long-lasting, irreversible conditions.

Consequences of Delaying Medical Care

Transcript

Welcome to Mason City Docs On Call, a podcast series with MercyOne North Iowa specialist who educate us about how to stay healthy. I’m your host, Carol Gifford.

Carol Gifford:

Hello and welcome to our Mason City Clinic healthcare podcast. And I’m here with Dr. Denisa Hagau, a board-certified cardiologist at MercyOne North Iowa cardiology care at the Mason City Clinic. So welcome to the program, Dr. Hagau.

Denisa Hagau:

Thanks for having me, Carol.

Carol Gifford:

Today we’re going to talk about a disturbing new trend that Dr. Hagau and her colleagues at MercyOne have experienced of people who have heart disease, either knowingly or not knowing delaying seeing their primary care physician or cardiologist out of fear of getting COVID. And so they wait too long to see their doctor or they’re afraid to come into the emergency room, and sometimes it’s too late to get the proper care. So doctor, tell us about this. Tell us about when you started noticing people’s fear of coming in and seeing their physicians or coming into the emergency room. And then what are the consequences for patients if they wait too long?

Denisa Hagau:

Sure. So initially it was at the first wave of the pandemic around, I would say March or April 2020. We noticed that the rate that the heart patients presenting with acute heart attack, like sudden chest pain, just classic heart attack symptoms due to an artery being completely plugged up, subsequently the heart would not see blood flow to that area of the heart. We noticed that there’s much less patients coming in than compared to the year prior to the point that maybe in one month we had one or two, when other times you would have two to three a week presenting with the sudden heart attacks. So at that point, it was clear that interviewing those patients coming in later and asking that how come they did not come at the time of symptoms and maybe they would present one or two weeks later when they would have consequences of these heart attacks. They mentioned that they were scared of COVID that coming to the hospital, people are full of COVID and they’re not feeling safe of coming in, so they would not come in.

Carol Gifford:

So how interesting, they were more afraid of getting COVID and what that would do to them versus having potentially a heart attack or experiencing a heart attack and not getting the proper care.

Denisa Hagau:

Correct. And the problem is the consequences of an acute heart attack, like acute occlusion of an artery that supplies blood flow to the heart, the biggest consequence is sudden death. So many patients we probably have not even seen because they may not make it to the emergency room or hospital because they would die suddenly from abnormal rhythm due to the fact that you’re not getting blood flow. Your heart goes into this ventricular rhythm that you guys see on TV like V-fib or V-tach, they call it. But the patients not coming in you cannot intervene. You cannot open that artery and restore blood flow to the heart in timely fashion. So we have 90 minutes to do that. And if patients do not present in time after 90 minutes, even if you open that artery, you may not restore the function of the heart. So you are left with consequences of congestive heart failure.

Carol Gifford:

Wow.

Denisa Hagau:

So if you make it, and you don’t die. You are not opening the artery; you literally have reduction in the function of the heart, and you end up with congestive heart failure.

Carol Gifford:

Wow. So it’s a whole new disease. So they’ve created a whole new disease that’s chronic and long term for themselves?

Denisa Hagau:

Lifelong disease.

Carol Gifford:

Wow. Wow. And you’ve seen lots of these patients recently?

Denisa Hagau:

Initially we’ve seen lots of these back in 2020, I would say that has gotten better now. They would come in for these acute sudden problems. People maybe feel more comfortable, or they’ve gotten used to the pandemic, I’m not sure. The problem right now that we see is on the chronic side. First of all, people who are middle-aged and haven’t seen a primary doctor in five years, they never check anything. They don’t check their blood pressure. They don’t check their cholesterol; they don’t check their blood sugar. So they don’t know whether they’re diabetics or not. And they may go with the blood pressure 160, 170, which is quite elevated without knowing, and even actually developed some form of hypertensive heart disease and then may or may not seek care. So we see delay in early detection on previously easily detectable conditions like high blood pressure, high cholesterol, diabetes.

Denisa Hagau:

And on the second spectrum is patients with known heart disease that I see in the office and my colleagues see in the office, let’s say someone has history of congestive heart failure, or they had a prior heart attack, and they had a stent maybe or bypass surgery. They may not come in for the last two years because of COVID and they don’t have doctors checking their medications. Actually, I saw a patient yesterday, that’s a clear example, his heart function was severely reduced back in 2020 due to a heart attack. And in this situation, if your heart function is severely reduced, you are at risk of having that ventricular tachycardia because the scar can cause that. So we routinely recommend a defibrillator placement. And I ask him, sir, how come you haven’t been seen since 2020, because in general we recommend a defibrillator when your heart is so weak. Well, I was scared of COVID.

Denisa Hagau:

Well, I think the majority of people do not realize that we’ve been having this COVID now since 2020, subsequently we have things in place to prevent you from developing COVID while you come and see a provider. I think it’s riskier to go to a gas station without wearing a mask or go to a grocery store without wearing a mask you’re higher risk of catching COVID than coming to a routine follow up in either primary doctor’s office or a cardiology office.

Carol Gifford:

Right. So what do you think you can say to these people? The ones that should be, what you were talking about, either getting their cholesterol checked, getting their blood pressure checked or people with known heart disease that really need to stay current with their medications and seeing their cardiologist. What can you say to them to assuage their fears? Because it does seem like it’s one of the safer places to come is a hospital or a clinic, right?

Denisa Hagau:

So managing the conditions like diabetes, congestive heart failure, your high blood pressure is as important as catching coronavirus itself. Because if you manage these chronic conditions and let’s say you develop coronavirus, your chances of having severe complications are less because those conditions are well managed. As opposed, let’s say your diabetes is not controlled, you have congestive heart failure and you are not being managed regularly by your provider. And then you develop coronavirus, because unfortunately now you can get it anywhere, even staying at home and not seeing anybody it’s just so rampant. Then your chances of being much sicker are much higher because those conditions are not managed well, we call it decompensated.

Carol Gifford:

Wow. Right.

Denisa Hagau:

It pays to come in because we clearly screen patients. Obviously, the temperature checks at the front desk, the checking process is different. Our cleaning process is different. The amount of patients we see is less at the same time. So it’s not like you’re bumping into someone every second. Obviously there are masks and social distancing. So patients having symptoms, they usually do not come and see the cardiologist like COVID symptoms I mean. So you would not be exposed to someone coughing next to you.

Carol Gifford:

Right. So do you think this trend is going to lessen somewhat as we start getting into, what do they call it? The endemic stage of COVID. Even though we’re not out of it, we’re getting through it a little bit, right? Or what do you think?

Denisa Hagau:

Yes. I thought it would lessen because we go to the YMCA or we go to the grocery store. People are scared and mostly not wearing a mask and they’re really comfortable in the community. And that being said, they still postpone the routine care. And that’s what I do not understand right now. If you go to a restaurant, no one’s having a mask and there’s a bunch of people and you’re not scared, but you are just delaying life saving care. It’s just disturbing. And this goes also for cancer detection. So my colleagues in oncology have seen patients with very delayed presentation that at this moment you can’t do anything else because it’s too late. When before they would’ve caught them a year early and then start treatment and be successful. So it’s really, really troublesome.

Carol Gifford:

Right. So the risk is much higher of not seeing your doctor, your cardiologist, your oncologist, than whatever COVID would bring to a patient, right?

Carol Gifford:

If you’re vaccinated, if you do get COVID, typically those symptoms are less than they were two years ago, correct?

Denisa Hagau:

Correct. They’re milder and self-limiting, and you can usually stay at home and be okay in a few days as opposed to not being, yeah.

Carol Gifford:

So what is your key message then to the general population around Mason City in terms of just getting them to understand what the risks are, COVID versus really seeing your primary care cardiologists or specialists for either heart disease or something else?

Denisa Hagau:

So I’m putting myself in their shoes, but I want people to be more accountable for themselves. And not wait to be called by the primary doctor or to be called by so and so office, I want them to take the first step. Okay. I haven’t seen anybody in X time. I think it would be time to at least check my blood pressure. I think it’s time for a routine blood work to make sure my sugar is not significantly high. And this is for someone who has no medical conditions. So be accountable, be responsible and check yourself out at least once a year. Someone having chronic illnesses, same thing. Even let’s say I’ve seen someone and I recommend, see us back in six months please. Let’s make sure that things are okay and we do not need to make any other adjustments. Do not wait to be called for that appointment.

Denisa Hagau:

You make a reminder on your fridge a month or two ahead of time. Okay. Let me call and make sure that I’m getting in at this time. If something you’re not feeling well, do not wait to three weeks later to seek medical care. I can tell you another very concrete example of a patient who passed out, out of the blue, boom, she passed out. Very scared, said that, yes, I should have called 911, but I didn’t. I just didn’t know what to do. I didn’t call for anyone for help. I was like, I understand that. It’s hard to know what to do at that time. She was by herself. I was like, but this happened five weeks ago. How come you not call us at least to see you, try to figure things out? I don’t know. So it’s very important when something’s not going well, you are just not feeling well, you don’t know what’s going on because it’s hard to diagnose yourself. You have to see someone.

Carol Gifford:

Yes.

Denisa Hagau:

Simple as that.

Carol Gifford:

I’m surprised, it seems illogical because-

Denisa Hagau:

I know as a patient perspective, when I was pregnant and I wasn’t feeling well, I just didn’t know what’s going on. And I was short of breath. I was like, yes, maybe it’s because I gained God knows how much weight. I didn’t even think of checking a simple blood test to see that I’m anemic because you don’t think like doctor. You as a patient when something’s happen, you just don’t know what’s going on. But immediately, I told my doctor, she’s like, oh yeah, let’s check a CBC. Sorry enough I was anemic. So you have to see her in order to have a timely diagnosis that leads to a timely intervention that leads you to feel better and not have a long lasting irreversible condition.

Carol Gifford:

Yeah, exactly. And well, I have one more question. So is there an option for people that are nervous about coming into the clinic or the hospital to do telemedicine appointments?

Denisa Hagau:

Yes, we do that. I do that. Some patients, let’s say, they’re in a nursing care home or something like that, but frankly we would be so much more helpful if I could just lay eyes on you. Put the stethoscope on your chest. Look at you as a person, even the color of the skin. And I can tell if something’s off so much more helpful for a clinician to see you in person. And actually some studies show that patients who were seen with telemedicine were ordered less tests and less medications. Because again, it’s so hard to tell …

Carol Gifford:

Yeah, no, I know you want to lay eyes on them in person, I totally understand it. But for some people that are a little nervous that is an option. And then maybe they can come in at a later date. Well, this is really important information. Who knew that this would be a consequence of COVID? Well, hopefully we’ll turn a corner. I think getting this message out there is really important. And just helping people understand that it is really a very safe place. The Mason City Clinic, MercyOne North Iowa, and you’re doing all of the protocols to keep people, like you said, socially distanced and safe and everyone should have a mask, but it’s better. The risk is higher to not come and see your doctor. So you just have to and be proactive about it is what you said.

Denisa Hagau:

Yes. Very, very, very important. You have to take a responsibility for it and we want to make sure you stay healthy and doing as well as you can. And our doors are open. We’re here to help you, but we cannot help you if you do not come in.

Carol Gifford:

Yes. Right. And besides heart attack, I had a friend, a female, early 60s and she just went to a primary care doctor and her blood pressure was off the charts. she had none of the symptoms you just described, but that was like a heart attack waiting to happen or a stroke waiting to happen. And so that was a real wake up call and she got the proper medication to get her blood pressure and her cholesterol perfect. But she had no idea. She just went and had an annual. That to me is even scarier. There’re no symptoms. That’s like what you were saying before. That’s why it’s so important to go see your primary care physician to just get those basic tests to make sure everything’s okay.

Denisa Hagau:

That’s a perfect example, Carol, because your blood pressure may be slowly increasing. You get used to it. Do not feel a headache or any symptoms from having high blood pressure. And if you do not check it, yes, you may live with the blood pressures 180, 190 until you develop a stroke or a heart attack. So that’s perfectly to what I was saying, if you do not check it, there’s no way knowing or preventing something very preventable. Most of our cardiovascular disease is preventable.

Carol Gifford:

Right.

Denisa Hagau:

There’s a program on CDC, they call it Million Hearts. They’re trying to prevent a million heart attacks or heart disease in the next five years. There’s a big campaign about that. But if you’re not proactive about it, we can’t help.

Carol Gifford:

Right. It’s all about prevention, checking and then living a healthy life, right? Getting exercise, eating well, getting your sleep. So, all right. Well, this is all really great information Dr. Hagau and hopefully we will get a lot of people to hear your messages because they should come in and see their doctor.

Denisa Hagau:

They just have to see someone, anybody.

Carol Gifford:

Yeah. All right. Well, thank you so much and happy Heart Month to you.

Denisa Hagau:

Take care. Bye-bye.

 

Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcasts.