The fear of encountering COVID-19 at civilian hospitals and emergency rooms is likely keeping patients away even if they are having a cardiac event, according to Air Force Col. (Dr.) Bryan White, a cardiovascular specialist at the Mike O'Callaghan Military Medical Center located aboard Nellis Air Force Base, Nevada.

"The ERs have been overwhelmed. If you have a cardiac disorder, it can be scary to think of going to where there are COVID-19 patients and long waits in crowded conditions," White said.

As a result, many elderly patients are presenting much later in the course of their disease, with more advanced and possibly irreversible symptoms and disease, White added.

Due to the pandemic, many heart patients are also self-isolating. This leads to a more sedentary lifestyle because they are afraid to go to stores, which then leads to more unhealthy diet and exercise habits. They are also becoming depressed and/or anxious, or developing or worsening hypertension, all of which are contributing factors to heart health decline.

"The risk factors were there pre-COVID-19, but have increased," White said. "Even though patients are doing a good job at avoiding COVID-19, the increased stress, anxiety, and isolation are taking their toll."

In contrast, Nellis beneficiaries "are happy to come in" he said, "because elderly patients want the care" and know that they can make a one-stop shop by also getting their prescriptions on base as well as getting diagnostic procedures and lab work done, thus lessening the need to drive to multiple stores or centers that could increase their exposure to COVID-19.

To mitigate exposure, the 99th Medical Group that operates the Nellis military medical treatment facility has staggered appointments, and follows strict Centers for Disease Control and Prevention COVID-19 protocols.

Nellis patients can come in person or use telehealth. White sees patients face-to-face, while other cardiac specialists see patients virtually. Nellis is also looking to acquire more COVID-19 vaccines, especially for the retiree and beneficiary populations, he said.

"I agree that patients with cardiac conditions are avoiding the hospitals and ER due to fear of COVID-19 exposure," said Navy Lt. Cmdr. (Dr.) Olamide Oladipo, chief of cardiology, Navy Medical Center-San Diego. "I cannot speak to whether the isolation, depression, anxiety and sedentary lifestyles are making more cardiovascular patients sicker" due to lack of data.

"I can say that cardiovascular patients at NMCSD are followed regularly using virtual tele-visits, and patients who need visits at the facility for any reason are given in-person appointments," Oladipo said.

To ensure everyone’s safety and reduce potential COVID-19 exposures at NMCSD, patients and staff members are screened before getting to the clinic on a regular basis with temperature checks and by answering simple screening questions for COVID-19-related symptoms.

"We also developed a staggered appointment process to space out in-person encounters and prevent multiple patients at one time in the waiting area," Oladipo said.

Whatever the perception, it is highly likely that COVID-19 is having a negative impact on cardiovascular care across the nation. But what makes care distinctive for Military Health System service members, retirees, and beneficiaries is that military medical treatment facilities are a known and safe entity they can count on.

"It's the community aspect to military care that makes it special," White said.