COVID-19: Advice for individuals living with heart disease or stroke

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

Updated June 8th

What do the latest restrictions mean?

We are now in the recovery phase of the response to the pandemic – reopening society and the economy as the vaccination programme progresses. However, we need to continue to follow the public health guidelines in these coming weeks. Practising those individual everyday measures is what will secure Ireland’s recovery from the pandemic.

The vaccination programme continues to make significant progress and the Government is now in a position to lift a number of public health restrictions during June. Plans for further easing of measures over the summer, subject to prevailing public health advice, have also been set out.

Read about the current government restrictions on gov.ie

Reminder: 

  • Washing your hands properly and often will help to stop the spread of COVID-19.
  • Wearing a face covering reduces the spread of COVID-19. It also helps stop the spread of the virus from people who may not know they have it. By law, you have to wear a face covering on public transport in shops, shopping centres and some other indoor settings. You should also wear a face covering when staying 2 metres apart from people is difficult and in busy outdoor spaces where a lot of people gather.

Covid-19 Vaccinations 

Should I get the vaccine?

COVID-19 (coronavirus) is a highly infectious disease which can cause serious illness, hospitalisation and even death.

COVID-19 vaccines offer protection from COVID-19. If you do catch COVID-19 after vaccination, you should be protected from the serious illness the virus can sometimes cause.

Getting vaccinated against COVID-19 is not mandatory. But we strongly recommend that you get your vaccine when it’s offered to you.

People who are most at risk from COVID-19 will be vaccinated first.

There’s no charge for getting your COVID-19 vaccine. It’s free. You can not get it privately.

When will I be vaccinated?

The rollout of COVID-19 vaccines is underway. Vaccines are being given as soon as possible after they arrive in Ireland. The HSE’s priorities are safety and working to protect people as quickly as we can. The rollout of vaccines will only be limited by supply. People who are most at risk from COVID-19 are being vaccinated first.

For further information on when you are likely to receive you vaccine, see here.

Is the vaccine safe?

The work to develop COVID-19 vaccines moved much faster than usual to make them available as soon as possible.

They have still gone through all the usual steps needed to develop a safe and effective vaccine. No short-cuts were taken.

COVID-19 vaccines could be developed quicker than usual because:

  • There was huge, global investment into their research.
  • The high number of new cases of COVID-19 across the world meant the vaccine trials could quickly measure differences in disease risk.
  • Large scale manufacturing of vaccines started before the results of trials were available.
  • Regulators and those developing the vaccines started their conversations very early so, the authorisation process could be as quick as possible.

For further information about the COVID-19 vaccines licensed for use in Ireland, see here.

COVID-19 vaccine information for heart patients

Read the European Society of Cardiology’s question page here. 

More Information

A message from Prof. Bill McEvoy, Consultant Cardiologist

A message from Prof. Bill McEvoy, Consultant Cardiologist, Medical and Research Director National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre.

COVID-19 has had a major impact on all our lives. While we still have much to learn about this disease and the virus that causes it, we do know that adults with underlying medical conditions – inclusive of hypertension, diabetes, obesity, and cardiovascular disease – tend to have worse outcomes and become sicker when stricken by COVID-19. This is particularly true for adults over 70 years. While the death rate from this infection is less than 1% for most people, it can rise to 5-10% among the very old and those with many underlying medical conditions. Therefore, this is a serious disease that deserves ongoing our attention and vigilance.

One of the less known issues with COVID-19 is that it can result in complications among infected adults who were previously healthy. While these adults have a very high chance of surviving the infection (over 99%), they are consequently vulnerable to any long-term side effects and complications from the virus. Without doubt, these long-term complications appear to be UNCOMMON; however, they do exist. For example, we know that, in rare cases, COVID-19 can injure the heart (leading to damage from a condition called myocarditis or ‘type 2 myocardial infarction’). The frequency with which these cardiac complications happen, the exact reasons why they happen (hypothesized to be related to inflammation or an increased propensity for blood clotting among those infected), and the reversibility or responsiveness to treatment of these complications remains an open question. Long-term complications in other body organs have been reported also, so this concern is not just unique to the heart.

Therefore, until these questions are answered, I encourage you all, even if young and healthy, to take this disease seriously. If you do get infected, your chances of a complete recovery are very high. We should not live in fear. However, why take any chances, everyone has a role to play in reducing the spread of this virus and if we all take collective responsibility we will minimise the risk for everyone.

Key Messages

The key messages remain the same. We need to Stay Safe.

  • Physical distancing should continue to be maintained at all times.
  • Continue to follow good hand washing, respiratory hygiene and physical distancing because we know these work and are now more important than ever.
  • Face coverings are now required on public transport and should be worn in shops and shopping centres and in situations where physical distancing is not possible. For further guidelines and information about how to correctly fit/ remove face mask visit the HSE website.
  • If you have cold or flu like symptoms, even mild ones, it is important to isolate at home and call your GP
  • People over 70 years and the extremely medically vulnerable, remain at the highest risk of severe illness from COVID-19, and are advised to take extra caution. This includes people living with cardiovascular disease.  It is important that you continue to attend essential medical services such as GPs and receive medical care at home (if appropriate) to protect your health and wellbeing.

Is there any specific advice for individuals living with heart disease or stroke?

For heart and stroke patients, prevention is key. While it is normal to feel anxious about how this condition might affect you, you are at no greater risk of developing COVID-19 than anyone else. However if you do contract the virus you have a higher chance of developing complications.

As you are at higher risk of a more serious illness if you contract Coronavirus, you are being advised to stay at home as much as possible and to limit your social contact. We strongly urge you to take extra care in ensuring you follow all of the recommended precautions. Please see advice below regarding cocooning.

While all individuals with underlying cardiovascular disease are at increased risk of complications if affected by COVID-19, those at greatest risk include individuals who have:

  • Had a heart transplant
    • At any time in the past or more recently.
  • Are pregnant with a heart condition
    • Lung viruses can cause severe illness in pregnant women, particularly those with an underlying heart condition.
      • Heart conditions include: symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function), thickening of the heart muscle (left ventricular hypertrophy, pulmonary hypertension, a moderate / severely narrowed or leaking heart valve, heart failure that affects your left ventricular function, or significant congenital heart disease.
  • Had recent open heart surgery
    • Including coronary artery bypass grafts (CABG) and valve repair or replacement.
  • Heart failure
    • Especially if you have been recently diagnosed, it affects your activities of daily living or you have been recently hospitalised for treatment.
  • Heart valve disease
    • Where this is severe disease or you have ongoing symptoms or are awaiting valve surgery.
    • A heart murmur in itself where you do not have symptoms or not diagnosed with valve disease does not increase your risk.
  • Congenital heart disease
    • There are many types, but in particular if you have complex disease or have other underlying conditions increasing your vulnerability.
  • Cardiomyopathy
    • Any type if you have ongoing symptoms or your daily activities are limited.
  • Angina
    • That limits your daily activities or means you have to use your GTN spray frequently.
  • Heart disease with other health conditions such as chronic kidney disease and lung disease.

With the emphasis being on minimising contact outside the home, it is still important to maintain your healthy lifestyle habits and not to disregard your usual exercise routine. As it may not be possible to continue outdoors, please visit the Croí website for lots of helpful health tips and advice to keep you on track.

Refill your medication prescription as normal and have over the counter medications such as paracetamol and a thermometer in your home. There is no disruption to the supply of medicines and therefore there is no need to order more medicines than you need.  Ask a family member to collect any medicines you need. If you do feel unwell, it’s still really important to carry on taking any medication you’ve been prescribed and speak to your doctor if you have any concerns.

Look after your emotional health and well-being. Any unexpected changes to our daily lives can be a source of stress and COVID -19 is no different. It is important to obtain information from reputable sources and focus on the facts rather than opinions on social media.

Cocooning

What is cocooning?

Cocooning is a recommendation from the HSE and the Irish government to protect those who are most at risk of developing serious complications if they contract the COVID-19 virus. Cocooning aims to minimize interaction between those most at risk and others.

What should I do?

  • Try to stay at home as much as possible.
  • Avoid physical contact with other people.
  • Limit your social interactions to a small social group for short periods of time – this is sometimes called a “social bubble”.
  • People who visit to help care for you should still attend as long as they have no symptom’s of COVID-19. Ask them to wash their hands on arrival and when possible keep 2 meters apart.
  • Avoid anyone who is sick. If you usually have carers, have a backup plan in case one of them becomes unwell.
  • You can ask your family to keep in touch with you via WhatsApp, video or social media so you don’t miss out.
  • If you need to contact your GP, use the telephone.
  • You may leave the house to get fresh air or exercise within 5km of your home, if social distancing is observed.

 Do I need to Cocoon?

The HSE have advised the following people to cocoon:

  • people aged 70 years or over
  • solid organ transplant recipients (including heart transplant)
  • people with specific cancers, rare diseases, respiratory conditions
  • women who are pregnant with significant heart disease, congenital or acquired

In addition to HSE recommendations, international cardiac societies advise people living with the following conditions to cocoon:

  • Heart conditions include symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function)
  • Had recent open heart surgery
  • Heart failure
  • Heart valve disease– that is moderate or severe
  • Significant congenital heart disease
  • Cardiomyopathy-any type if you have ongoing symptoms or your daily activities are limited
  • Those with Angina that limits your daily activities or means you have to use your GTN spray frequently

What are the symptoms of COVID-19?

The main symptoms to watch out for are:

  • A cough
  • A high temperature
  • Shortness of breath
  • Breathing difficulties
  • Loss of taste or sense of smell

Other symptoms are fatigue, headaches, sore throat, aches and pains. But these symptoms do not necessarily mean you have the illness. The symptoms are similar to other illnesses that are much more common, such as cold and flu.

If you are experiencing any of these symptoms and are concerned you should contact your GP for further advice.

How to avoid catching or spreading COVID-19

Coronavirus is spread by droplet infection – coughing and sneezing or by close contact with someone who has the virus. As it’s a new illness, we do not know how easily the virus spreads from person to person. Spread is most likely from those who have symptoms.

In accordance with recent guidelines, people should stay at home as much as possible to limit close contacts. You should only leave home to:

  • Go to work
  • Take children to school or childcare
  • Go to shops for essential supplies
  • Care for others
  • Attend hospital and medical appointments
  • Avoid hand shaking and close contact with people- keep a distance of 2 meters (6.5 feet) between you and others
  • Work from home if, and where possible
  • Make a joint plan with family friends and neighbours on what to do if you become ill

Travel

Self-quarantine and self-isolation

  • To help stop the spread of Coronavirus, you may need to either self-quarantine or self-isolate:
    • Self-quarantine means avoiding contact with other people and social situations as much as possible. You will need to do this if you are a close contact of a confirmed case of coronavirus and you are still well.
    • Self-isolation means staying indoors and completely avoiding contact with other people. You will need to do this if you have symptoms of coronavirus.

Other Do's and Don't's

Do:

  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Always wash your hands when you get home or arrive at work
  • Use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin straight away and wash your hands afterwards
  • Try to avoid close contact with people who are unwell

Don’t:

  • Do not touch your eyes, nose or mouth if your hands are not clean
  • Do not share objects that touch your mouth. For example, bottles and cups
  • Do not shake hands
  • Don’t have visitors to your home, unless they are helping with your care needs

Further information

For further information you can visit the following websites:

Further information on latest updates can be found on the Government’s website.

The Croí Health team are determined to stay connected with all our groups and supporters and aim to keep you informed and up to date on a regular basis. We will continuously explore the latest evidence on COVID-19 and cardiovascular disease and will share this important information with you.

Everyone has a role to play in reducing the spread of this virus and if we all take collective responsibility we will minimise the risk for everyone.

Croí Connects – Your questions answered

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Welcome to Croí’s weekly Q&A series, Croí Connects

Through this new series, Croí will connect with medical experts each week for a questions and answers session to help answer your questions on heart disease, stroke, COVID-19 and lots more. Our Croí Connects video series will be shared here and on our Facebook page.

Each month we will announce our upcoming guest expert on Croí Connects. You are invited to submit your questions the week in advance. Your questions can be submitted using the form below, or you can call Croí on 091-544310.

Stay tuned for our next Croí Connects!

Croí Connects: Weight Bias and Obesity Stigma

Croí Connects: Sleep Management

Croí Connects: Stress Management

Croí Connects: World Heart Day Special

Croí Connects: Heart Valve Disease

Croí Connects: Obesity

Croí Connects: Diabetes

Croi Connects: Heart Attack & CPR

Croí Connects: Mayo Farmers Month Special

Croí Connects: World Stroke Day Special

Croí Connects: ICD

Croí Connects: Physical Activity

Croí Connects: Heart Failure

Croí Connects: Stroke

Croí Connects: Diet & Nutrition

Croí Connects: Heart Disease

Patient-led COVID-19 Response Campaign

With the COVID-19 pandemic continuing to threaten the lives of people with new onset cardiac conditions and people living with existing cardiac health challenges, the Global Heart Hub, an international alliance of heart patient organisations, has launched a ‘patient-led’ COVID Response Campaign. The aim of this international campaign is to save lives, reduce disability, increase awareness and drive action. Croí is a member of the Global Heart Hub and supports this campaign.

The pandemic has disrupted the world and, in particular, our personal health care and healthcare systems. Many people are slow to seek medical help when experiencing obvious cardiac symptoms. Many remain fearful of going to their doctor or to hospital. Many are cancelling important medical appointments. These delays in seeking help and commencing treatments can be life-threatening. It’s time to put heart health before the fear of COVID-19. You are 10 times more likely to die from a cardiac event than from COVID-19.

The campaign encompasses three important messages:

  • In recent months, many people with heart and stroke emergencies have delayed seeking medical help because of their fear of COVID-19. The #JustGo message is simple – when experiencing symptoms of heart attack or stroke, don’t delay, seek medical help. When your heart says so, #JustGo.
  • The #StepUp message encourages patients to be informed, know their symptoms and be assertive about their heart health. When your heart needs you, #StepUp.
  • The #JustTreat message is important for healthcare providers who have had to re-prioritise hospital resources, resulting in significantly impacted heart services. Because time is crucial, #JustTreat.

National Clinical Societies and international organisations such as the World Heart Federation, The European Society of Cardiology, International Atherosclerosis Society (IAS), FH Europe and others have united to share these important messages. Ignoring cardiac symptoms or delaying treatment carries the risk of severe complications and potentially life-threatening consequences.

According to recent research by the World Heart Federation, since the start of the pandemic there has been an increase of up to 139% in heart disease-related deaths. Attendance at hospital appointments has dropped by 76% globally. The number of heart attack patients seeking urgent hospital care has dropped, with a 58% increase in people having cardiac arrests at home. Across the world there has been a large decrease in cardiac admissions to hospital (across all cardiac conditions) and there has been a significant decrease in hospital interventions both surgical and less invasive.

National Clinical Societies and international organisations such as the World Heart Federation stand firmly behind this patient-driven initiative aiming to save lives. As leaders of the global heart community, they encourage healthcare workers to treat cardiovascular disease patients as effectively and quickly as possible, which includes making sure they get to them in time. During the COVID-19 pandemic it may be easy to overlook other diseases that affect our lives, and which can cause more damage in the long run. The international patient community encourages the media and the medical profession to spread this important message and help counter fear in times of uncertainty.

The repercussions of COVID-19 on the burden of cardiovascular disease requires unprecedented global health policy action. COVID-19 has impacted heart patients due to postponed appointments, delayed or cancelled procedures, with heart valve surgery and structural heart procedures being the worst hit by cancellations. Delayed or avoided cardiac care increases the risk of long term irreversible damage and even death.

Global Heart Hub’s COVID Response Campaign reaffirms medical advice to always act quickly when it comes to symptoms of heart disease. Early recognition of symptoms is key to ensure the best possible treatment and health outcome. The campaign also aims to reassure patients that the risk of coronavirus infection in hospital has been minimised for patients being admitted.

Learn more by visiting: croi.ie/covid-response/

Patients Voice Concerns over COVID-19 Vaccine Prioritisation

Croí joins Patient Organisations to Urge Government to Prioritise People with Chronic and Rare Diseases, of All Ages, in Rollout of COVID-19 Vaccines

A coalition of patient organisations, including Croí, has today written to An Taoiseach and to the Chair of the High-Level Task Force on Vaccination and Immunisation to urge that people with chronic and/or rare diseases, of all ages, be treated as the highest priority in determining early vaccine recipients. Already, many countries around the globe are including this group as a top priority and it is vital that Ireland likewise recognises the importance of doing so.

The coalition is also calling for representatives from the public to be allowed join the membership of the Task Force and for patient organisations and vulnerable group leaders to be urgently engaged in dialogue.

The coalition of fifteen patient organisations comprises: Alone, Alpha 1 Foundation, Asthma Society of Ireland, COPD Support Ireland, Diabetes Ireland, Disability Federation of Ireland, Family Carers Ireland, Irish Cancer Society, Irish Heart Foundation, IPPOSI, Mental Health Ireland, The Neurological Alliance of Ireland, Rare Diseases Ireland, Sage Advocacy, and The West of Ireland Cardiac and Stroke Foundation.

Vaccination Priority

Derick Mitchell, Chief Executive of IPPOSI (the Irish Platform for Patients’ Organisations, Science and Industry), comments:

“Many chronic and/or rare disease patients manage one or more life-threatening and/or life-limiting conditions. Many have been cocooning since news of the pandemic broke in early 2020. This has had devasting effects for patients and their families – emotional, physical, and financial.

“These are patients who cannot participate in the ‘new normal’ in any way, they cannot ‘risk it’. They cannot rely on social distancing, on mask wearing, or on hand sanitising. To protect their physical health, they must cocoon or self-isolate – completely, indefinitely, and some alone.

“Patients have endured this level of isolation for ten months now and it is critical that they not endure this for a moment longer than is absolutely necessary. We strongly urge the Government and the High-Level Task Force to consider the needs of some of the most vulnerable in society, of all ages, when making its final decisions as to what groups will receive immediate vaccination priority.”

Task Force Membership

Vicky McGrath, Chief Executive of Rare Diseases Ireland, comments:

“The welcome developments announced in recent weeks by several COVID-19 vaccine candidates are forcing us as a society to address some difficult questions.

“As things stand, dialogue and decisions around the priority groups in line for future COVID-19 vaccines are being taken by a select number of departmental and public authority officials. The 15-member task force includes the Department of Health, the HSE, the Department of Enterprise, Trade and Innovation, the Health Regulatory Authority, the IDA, the Dublin Airport Authority, but not a single representative from the public, or from patient or vulnerable groups. We are therefore calling for the appointment of two representatives from the public to join the membership of the Task Force and for patient organisations and vulnerable group leaders to be included in an ongoing dialogue.”

Kieran O’Leary, Chief Executive of Diabetes Ireland, adds:

“We all recognise that, at least initially, there may not be enough vaccines for a widespread immunisation programme. Demand between countries, and within countries, will outstrip supply. Nationally, we will have to prioritise who receives the first allocation of vaccines.

“Allocation must be made on the basis of agreed ethical values and clinical evidence, in a transparent and accountable environment, where public, patient and vulnerable group representatives are able to voice the perspectives of the most at risk in our society.”

Distressing Time

Benat Broderick, Cystic Fibrosis patient advocate, shares:

“As a person living with Cystic Fibrosis, the pandemic has left me with no other choice but to cocoon since early February, due to the risk posed to my personal health. As others have benefitted from an easing of restrictions or a return to a new normal, I however, continue to endure a very worrying and draining set of circumstances. My only hope of re-joining society in any meaningful way, is access to a vaccine. I therefore fully support the call for patients and vulnerable people to be placed among those in the highest category for vaccination.”

Heart & Stroke Charity says #JustGo if you are having a Heart Attack or Stroke

Today (Monday June 15th, 2020) the Heart & Stroke Charity Croí, launches a national ‘patient-to-patient’ confidence building campaign aimed at saving lives and reducing disability by encouraging those with symptoms of heart or stroke emergency to seek medical help without delay. The #JustGo initiative reaffirms medical advice to always act quickly when it comes to symptoms of a heart attack or stroke. ‘Time is muscle’ – the longer you wait with a heart attack the more damage occurs to your heart muscle or in the case of a stroke, to your brain.

The campaign is in response to the fear of COVID-19, which is keeping almost half of people suffering from a heart attack away from hospitals, and now across the world, doctors are reporting that those who delay in seeking medical help are in a far worse condition when they finally arrive at hospital, and it’s often too late to benefit from the life-saving treatments that are normally available to them.

“It’s one of the unintended consequences of COVID-19 that people suffering heart attacks and strokes are delaying in seeking medical help, resulting in worse outcomes. Also, people living with known heart conditions who are experiencing new or worsening symptoms are delaying too long before calling their doctor or going to hospital,” says Neil Johnson, CEO, Croí.

National Clinical Societies and international organisations such as the World Heart Federation, World Stroke Organisation and the European Society of Cardiology are all united on the important message that ignoring cardiac symptoms or delaying treatment carries the risk of severe complications with long-term negative and potentially life threatening consequences.

Professor Jim Crowley, Consultant Cardiologist, Galway University Hospital and President of the Irish Cardiac Society, says, “In Ireland, there has been a large decrease in cardiac admissions to hospital (across all cardiac conditions), in some locations a decrease of as much as 80%, and there has been a significant decrease in hospital interventions both surgical and less invasive of up to 35% across hospitals. This is very worrying as we know cardiovascular disease has not gone away and the prospect of a surge of patients with advanced cardiac symptoms in the coming weeks and months as an indirect consequence of COVID-19 is concerning.”

Professor Bill McEvoy, Consultant Cardiologist, Galway University Hospital and Research & Medical Director of the National Institute for Prevention and Cardiovascular Health, confirms that he has been seeing patients who left it too late to come into hospital for treatment of a heart attack or stroke. “We have seen severe complications of heart attacks that we haven’t witnessed in decades, from back before the time since we have modern treatments for heart attack. We need to get the message out to patients, loud and clear, that our hospitals are safe and that patients without COVID-19 are being kept separate from patients admitted with COVID-19. We also need to reinforce the longstanding message to patients – act quickly if you have symptoms of a heart attack or stroke.”

Dr Joe Gallagher, ICGP Primary Care Lead for Integrated Care Programmes (Cardiovascular Disease) speaking as a GP says, “It is really important to look after your heart at this time and if you are worried about your heart health talk to your GP.  Don’t delay in going to hospital if you experience symptoms of a heart attack or stroke.”

The #JustGo campaign message is simple and clear – If you are experiencing the symptoms of a heart attack, – Don’t delay – Every minute counts. If you have chest pain or other heart attack symptoms – such as pain in the throat, neck, back, stomach or shoulders that lasts for more than 15 minutes – you must call an ambulance.

Equally, if you are living with an existing heart condition such as heart failure or heart valve disease and if you are experiencing new symptoms, or a worsening of symptoms, you should contact your doctor or go to a hospital as soon as possible. Similarly, for those diagnosed with Familial Hypercholesterolemia (FH) (a genetic condition where the cholesterol level is very high and needs medical treatment to lower it) or for those under the age of 55, having a family member living with FH or multiple family members with a history of heart disease or stroke – don’t ignore the symptoms of heart attack, act quickly.

The #JustGo Campaign hopes to reassure people that the risk of coronavirus infection in hospital has been minimised for patients being admitted with heart attacks or strokes. The campaign also reaffirms that the risk of dying from an untreated heart attack is 10 times higher than dying from COVID-19.

Croí says – If you are experiencing a heart or stroke emergency – this is NOT the time to ‘stay at home’ – when your heart says so, #JustGo

Learn more: www.croi.ie/justgo

The #JustGo Campaign is endorsed by:

The National Heart
Programme Ireland

Irish Cardiac Society
European Atherosclerosis Society

Part of a global initiative by the Global Heart Hub in collaboration with FH Europe.

Supported by:

World Heart Foundation

Croí Responds to COVID-19 in the West of Ireland

New Service Launched for Heart & Stroke Patients & Carers

Local Heart & Stroke Charity Croí is responding to the increased needs of those living with heart disease and stroke, as a consequence of COVID-19. Since the beginning of the coronavirus crisis, Croí has been experiencing an ever-increasing demand for information, support and advice from heart and stroke patients and their carers.

“Our health team of community nurses, dietitians, physios and exercise specialists are receiving phone calls, emails and significantly increased web and social media correspondence from all over Ireland – with the greatest demand being from the west of Ireland” says Croí CEO Neil Johnson, who outlined the reasons for this as:

  • Increased fear, anxiety and worry among heart patients and their families due to their increased vulnerability to COVID-19.
  • Increased need for reliable information and reassurance from a healthcare professional.
  • Increased isolation and loneliness.
  • Reduced access (perceived and real) to GP’s, or community health services.
  • Reduced access to services (e.g. cardiac rehabilitation, heart failure nurse specialists etc.) due to redeployment of HSE staff or postponement of services.
  • Cancelled or postponed clinic appointments or hospital procedures.
  • Reduced quality time with doctors or nurses – quicker discharge from hospital; shorter appointments (e.g.: virtual clinics).

“Many people are afraid to visit their doctor or hospital, despite having symptoms that warrant attention and this will lead to adverse or worse outcomes,” said Johnson.

With funding support from local and national healthcare companies, Croí has launched a new community support service across the West of Ireland – Heartlink West – with endorsement from the cardiology services of the Saolta Group.

Announcing details of this new initiative, Croí CEO Neil Johnson said that: “Heartlink West will provide FREE support from our community based, multi-disciplinary health team, led by three highly-experienced cardiac nurse specialists. Concerned individuals can connect with us through a telephone helpline and daily ‘virtual health chats’. Those who call the helpline can speak with Nurses, Dietitians, Physios and Exercise Specialists. For the duration of the current crisis, we aim to provide this FREE service, Monday to Friday from 09:30 -17:30.”

Heartlink West has been made possible thanks to the support of several generous donations from regional and national companies. To learn more about this initiative or for ways to support us please visit www.croi.ie/heartlinkwest.

HeartLink West is available Monday – Friday from 9:00am – 5:30pm. Call 091-544310 or email healthteam@croi.ie.

Advice For Individuals Recovering From A Recent Cardiac Procedure

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Due to COVID-19, people admitted to hospital for cardiac care are being discharged quickly to reduce their possible exposure to infection. The consequences are that many patients and carers are not getting adequate time with doctors and nurses to understand their condition and its treatment. The following information has been developed specifically for patients who have just been discharged from hospital post a cardiac procedure.

It is important to remember that our hospitals will continue to treat heart patients where urgent emergency dictates. If you have symptoms that could be a heart attack or stroke, or if your heart symptoms get worse you should still call 999 for immediate assistance

WHAT SHOULD I DO IF I HAVE RECENTLY HAD OPEN HEART SURGERY INCLUDING HEART BYPASS AND HEART VALVE SURGERY?

Patients who have recently had surgery have an increased risk of infections due to cuts/incisions which may be exposed to germs. The normal risk of infection for open heart surgery patients is low, but in the current situation you should take every extra measure to limit your risk of infection.

It is important to keep the wound site clean and dry. Observe for any signs of infection such as, redness around the wound, discharge from the wound which may be evident on the dressing, and pain or swelling around the wound site.

Your medical team will have advised you on your expected recovery before being discharged home. This includes making sure you take lots of rest in the first 2 weeks following surgery. In this time, you should continue to do gentle exercise around your home and garden. You should avoid leaving your house and follow the COVID-19 recommendations on the website around cocooning.

You should eat a healthy, well balanced diet to boost your healing and recovery.

If you do begin to feel unwell you should contact your GP, hospital medical team or call the emergency services.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD A TAVI?

A TAVI (Transcatheter Aortic Valve Implantation) is a procedure that is used to replace the aortic valve. It is generally performed under local anaesthetic, but sometimes under general.

TAVI is a less invasive approach which allows the replacement aortic valve to be inserted via a catheter usually through a small incision in the groin. TAVI is now a recommended, safe and cost-effective alternative to open heart surgery for patients with severe symptomatic aortic stenosis not just at high-risk, but also at low and intermediate-risk of surgical complications.

If you have recently had a TAVI procedure, you have heart valve disease. This places you at higher risk of developing complications if you catch the COVID-19 virus.

On average it takes 2-3 months to recover fully from a TAVI procedure. Cocooning is advised to individuals who have had this procedure within this time frame.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD an Angiogram or Angioplasty?

Individuals who have recently had an angiogram or an angioplasty (plus or minus stents) are usually discharged from hospital the same or following day.

You can return to light duties within a few days and are usually safe to drive a week after the procedure. We would recommend against this at present due to the increased risk of exposure to the COVID-19 virus.

Heavy lifting should be avoided while the artery is healing. If you have had an emergency angioplasty, i.e due to a heart attack you will need to take a few weeks off work and follow the advice around cocooning. For more information on advice following a heart attack click here.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes worse or red and painful contact your GP via the telephone, for further advice.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a cardiac device implanted?

There is no evidence that the COVID-19 virus infects any type of implantable device, such as a pace maker or defibrillator. These devices can help stabilise your heart condition.

If you have recently had an ICD (Implantable Cardiac Defibrillator) or PPM (Permanent Pace -maker) fitted you should avoid heavy lifting and pulling with the affected arm for the first 4-6 weeks. This gives the device and leads a chance to settle in.

If you were advised that you had stitches in the wound site, you should still attend your GP or practice nurse to have these removed. Be sure to phone first to arrange an appointment.

You may have been told you will also need to have your device checked. This is usually around 6 months after insertion. You will be contacted by the cardiology department of your local hospital if this affects you. You may also have been set up with remote patient monitoring.

You may or may not notice when your ICD has delivered treatment, as this can vary from person to person. It can range from a fluttery feeling in the chest to an incredibly painful thump in the centre of the chest. It may be accompanied by feeling dizzy or faint.

If you experience this, you should contact your cardiac investigation team. If you continue to feel unwell after having a shock delivered you should contact the emergency services immediately.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a Cardiac ablation?

Ablation is a treatment used to treat some arrhythmias (abnormal heart rhythms). If you have recently had an ablation you may continue to have some symptoms such as palpitations following the procedure. This is very common and you shouldn’t let it concern you. It is usually takes 8-10 weeks following the procedure for doctors to determine if it has been successful.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes red and painful contact your GP via the telephone, for further advice.

Due to the COVID-19 pandemic it is unlikely you will have you’re follow up within 8-10 weeks. You will still be seen in your local hospital but it is likely it will be delayed. This is to keep both you and the medical staff safe. Until you have been reviewed by your consultant you should continue to take your medication, and contact your GP by telephone if you have any concerns.

Diet and Immune System

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Can diet help ‘boost’ our immune system to fight COVID-19?

While it is true that poor nutrition can hamper your ability to fight off illness and infection, it is misleading to think that a special food, nutrient or supplement can “boost” your immune system. There are many products being heavily promoted as “immune boosters”, however immunology is complex and there are no supplements or natural health products approved to treat or protect against the COVID-19 virus.

Alongside a healthy sleep pattern, regular physical activity and stress management strategies, now more than ever is a good time to develop a healthy eating routine.

A Balanced Diet

Following the key points below for a healthy balanced and varied diet with adequate energy and protein intake is important to best support your immune system and overall heart health.

  • Aim for 5 – 7 portions of fruit and vegetables per day (aim to include at every meal)
  • Choose brown and wholegrain versions of carbohydrates
  • Include 2 servings of lean protein per day e.g. fish, lean red meat and poultry, peas, beans, lentils and eggs)
  • Stay hydrated with water as your main fluid source
  • Limit high sugar/fat/salt foods to a few times per week

Below, we will take you through some of the key nutrients found in a balanced diet one and highlight the role they pay in supporting your immune system to work properly.

Click the image to download the Healthy Ireland Food Pyramid.
Click the image to download the Healthy Ireland Food Pyramid.

7 key nutrients for a healthy immune system

Protein is important for many bodily functions such as healing and repair and maintaining healthy muscle mass. It also has a role in the formation of antibodies that fight infection and disease.  Protein foods can be animal based such as meat, fish, poultry, eggs and dairy or plant based such as peas, beans, lentils, tofu and nuts. Vary your protein sources, choose lean meats and poultry and limit processed red meats to keep your diet low in saturated fat. Include fish twice a week one of which is oily such as salmon, mackerel, trout or sardines (tinned or fresh).

1

This vitamin is ace at supporting your immune system! It helps maintain the structure of the cells in the skin, respiratory tract and gut. It acts as an anti-oxidant which is kind of like anti-rust protection for our bodies cells, keeping them strong and ready to fight infection. Beta-carotene which is converted to vitamin A in the body is found in leafy greens, yellow and orange vegetables like pumpkin and carrots.

2

Vitamin E is also a powerful anti-oxidant and is found in green leafy vegetables such as spinach and broccoli. It is also found in avocados and vegetable oils such as sunflower and rapeseed oil and nuts and seeds including: almonds, hazelnuts and pumpkin. Why not try adding a handful of nuts or seeds to your cereal or using rapeseed oil in cooking and salad dressings.

3

Habitual vitamin C supplementation may help with the common cold by reducing severity and duration (>200mg/day) however we don’t know if this transfers to viruses. The recommended daily allowance (RDA) of vitamin C for most adults is 80mg which is easily achieved through a balanced diet. Foods rich in vitamin C include bell peppers, citrus fruits, broccoli, Brussels sprouts and berries. Fresh and frozen are equally as nutritious. While vitamin C supplementation up to 1000mg/day won’t do you any harm, excess consumption can result in stomach pain and diarrhoea.

4

Vitamin D works with calcium and phosphorus for healthy bones, muscles and teeth. Vitamin D also helps to regulate our immune responses and a recent review of the research found that vitamin D supplements can help protect against acute respiratory infections, particularly among people who are deficient.

This is one vitamin where supplementation is recommended, although we can make vitamin D in the skin through direct sunlight, in Ireland the sunlight isn’t strong enough between March and October. We can get some vitamin D from diet as it is found in foods such as eggs, salmon and fortified milk but typically we don’t consume enough of these foods to meet our needs. Taking a 10 micrograms per day supplement is recommended for adults and children over the age of one year. With the social isolation precautions our time outdoors may be restricted a bit more and so supplementation is more important than ever.

5

Zinc helps the immune system to work properly and plays a role in wound healing. The immune system works well when we consume the recommended daily allowance of zinc which is 10mg / day. It is rare to be deficient in zinc as it is present in a wide range of foods including; lean meat, poultry, seafood, milk, whole grain products, fortified breakfast cereals, beans, seeds and nuts.

6

Selenium is involved in the normal function of the immune system. Good sources include Brazil nuts (5-6 Brazil nuts provide an adults daily needs) fish and seafood, brown rice, baked beans, sunflower seeds and oats are also good sources.

7

Most importantly, please remember that correct and frequent hand washing is your first line of defense and to continue to physically distance yourself as much as possible to break the chain of transmission. For more information check out the HSE website.

COVID-19: Advice for individuals living with Heart Failure

This advice is based on information from the Heart Failure Patient Council of the Global Heart Hub. Croí is a member of the Global Heart Hub.

Covid-19 presents the world with an unprecedented public health challenge. Its rapid spread has caused significant alarm and disruption across the globe. Understandably, those living with heart disease and heart failure are anxious and concerned.

It is well established that many virus infections can affect the heart, and experts suspect that coronavirus is no different. Viruses are known to induce inflammation of the myocardium (heart muscle). While in a healthy patient this may not lead to an adverse outcome, the situation for those living with heart disease and heart failure is different. Evidence suggests that if these individuals become infected with coronavirus they are at greater risk of adverse cardiac events and the outcomes may be poor.

COVID-19 is a new illness that can affect your lungs and airways. It’s caused by a virus called coronavirus. With the number of cases around the world increasing on a daily basis, hospitals are experiencing an unprecedented increase inpatient admissions. Consequently, hospitals are cancelling clinics and l non-urgent activity.  Only urgent and emergency cases are being treated to reduce the strain on staffing and beds, and prevent vulnerable patients being exposed to the COVID-19 virus unnecessarily.

It is important to remember that hospitals will continue to treat heart patients, but the current pressures may result in delays, cancellations of appointments and disruption of services. The decisions on who will be treated will be based on clinical need, with those in most need of treatment being prioritised.

For further information on COVID-19 virus and symptoms see Croí’s advice here.

 

Staying well

For those living with Heart Failure:

  • Take all your medicines as advised by your doctor or nurse.
  • Do your best to follow all your medical advice on how to keep your condition well controlled.
  • Continue to self-monitor your condition and record your weight on a daily basis (first thing after you get out of bed in the morning).
  • Stay in regular contact with family, friends or neighbours as you may need to ask for help if you become sick.
  • Maintain a healthy diet – unless you have been advised to adhere to a specially prescribed diet, you should continue to try and eat a wide variety of foods that are rich in vitamins, minerals, fibre and other essential nutrients.

For Family and Caregivers:

  • Know what medications are prescribed and make sure supplies are secure.
  • Watch for new symptoms.
  • Prepare a plan to make sure food and other supplies are available when needed.
  • Consider options and have a plan for what would happen if you become ill.

 

What should I do if I experience gradual or persistent worsening symptoms of Heart Failure, such as my weight increasing or my legs swelling?

Self-monitoring of your condition on a daily basis is very important. It is equally important that you take your daily medicines as prescribed by your doctor.

If you experience any of the following worsening of symptoms, you should contact your GP, if available your Heart Failure Nurse or your local Heart Failure Clinic for advice and review of your medication. Due to the outbreak of COVID-19 many hospital staff have been redeployed. If you are unable to contact you heart failure nurse or team please contact your GP or local emergency department if you are concerned.

Worsening symptoms to look out for:

  • Weight increase greater than 3lb overnight or 5 lb (2kg) in a week .
  • Increased swelling in the legs or abdomen.
  • Increased shortness of breath on exertion, lying down or in bed at night.

If you have very sudden or very severe symptoms call for an ambulance so that you can be taken to hospital for treatment as soon as possible.

 

STAY CALM!

It is perfectly understandable that people may be feeling anxious or concerned about what might happen to them or their loved ones over the coming months. However, we must remind ourselves that this crisis will end. Only seek information from reliable sources – there is a huge amount of ‘fake news’ and false rumours which do nothing more than cause unnecessary anxiety and distress.

Already many heart patients are slow to respond to changes in their health or they are dismissing new symptoms because they do not wish to burden their doctor or local hospital. Despite the Covid-19 crisis, doctors and emergency rooms are still there to help heart patients so do not ignore worrying symptoms or delay in contacting them if you are unwell. Keep up to date with your local health information notices on how best to contact your GP or Heart Failure Nurse.  The Heart Failure Patient Council of the Global Heart Hub are being advised by medical and public health experts and we will keep you updated on any changes in information that could affect those living with Heart Failure.

 

See Croí’s health page for more information on heart failure.

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

COVID-19: Advice for individuals with Heart Valve Disease

People living with moderate or severe heart valve disease are at increased risk of complications if affected by COVID-19. Those at greatest risk are individuals with severe disease, significant ongoing symptoms or awaiting valve surgery.

It is important to remember that hospitals will continue to treat heart patients, but the current pressures may result in delays, cancellations of appointments and disruption of services.

This advice is based on information from the Heart Valve Disease Patient Council of the Global Heart Hub. Croí is a member of the Global Heart Hub.

What should I do if I am due to have heart valve surgery or have a heart valve procedure?

If you are due to have surgery you should continue to prepare for it unless told otherwise by your clinician. If your surgery is rescheduled for a later date you should monitor your symptoms closely. If your symptoms get worse and you begin to feel unwell you should report this to your GP, call your hospital medical team or in severe cases, call the emergency services.

 

What should I do if I have recently had heart valve surgery or a heart valve procedure?

Patients who have recently had a procedure have an increased risk of infections due to cuts/incisions which may be exposed to germs. The normal risk of infection for heart valve disease patients is low, but in the current situation you should take every extra measure to limit your risk of infection. If you do begin to feel unwell you should contact your hospital medical team or call the emergency services.

 

How do I reduce my risk of contracting the COVID-19 virus:

There is currently no vaccine to prevent COVID-19 and the best way to prevent illness is to avoid being exposed to this virus. As you are at higher risk of a more serious illness if you contract coronavirus you are being advised to stay at home as much as possible and to limit your social contact.

We strongly urge you to take extra care in ensuring you follow all of the recommended precautions.

You need to be extra vigilant, be aware of your symptoms and take the recommended precautionary measures by physically distancing.

 

What are the symptoms of COVID-19?

For further information on COVID-19 virus and symptoms see Croí’s advice here.

If you are experiencing any of these symptoms and feel you need medical help, you should follow the guidelines issued by your health authority on how best to seek medical help.

Any heart valve patient with progressive or new onset symptoms, particularly syncope (fainting, ‘passing out’ or collapse) should contact their doctor immediately.

See Croí’s health page for more information on heart valve disease.

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.