Preventing Future Pandemic Devastation Starts With the Heart

While the U.S. copes with COVID-19, we need to consider how much less deadly and devastating the pandemic could have been if the country had better underlying cardiovascular health. Seventy-one percent of patients requiring hospitalization and 78 percent of those in intensive care (and in danger of dying) had underlying chronic conditions including diabetes and hypertension.

Relative to other developed countries, and despite significant progress, the U.S. still has higher rates of diabetes and cardiovascular disease than all OECD countries. Cardiovascular disease is the leading cause of death in the U.S. and costs $220 billion a year. Imagine how many lives would have been saved if policymakers had treated the prevalence and severity of diabetes and hypertension as a threat to the nation during a pandemic? What if we had done more to address risk factors? Would COVID-19 have been less devastating to African Americans? With a more resilient population, COVID-19 could have been more like a flu — a devastating infectious disease, but one we manage without bringing the economy to a halt. And, if more people could have recovered from COVID-19 at home, fewer health care workers would have been exposed.

Significant progress has been made toward improving heart health particularly by smoking reduction. But we need to do more. Organizations such as the CDC offer roadmaps to reduce cardiovascular illness and mortality including increasing access to providers and treatment, data collection and monitoring. To be better prepared for this crisis and the next, we need to change financial incentives to encourage primary prevention and establish standards for data sharing and remote monitoring.

Until a few weeks ago, when federal regulators announced emergency waivers to broaden access, telemedicine was underutilized. It took an infectious pandemic to relax restrictions on this vital disease-management mechanism that allows people to access a health care provider when and where they need it (even though more people have been dying from strokes each year than are expected to die from COVID-19 this year).

Many more people with cardiovascular disease could have received routine care if the policy had been in place years ago. The U.S. should retain regulatory flexibility in telemedicine beyond the crisis and expand in-home monitoring for cardiovascular disease and exacerbating conditions like depression.

The U.S. has lower rates of mortality in conditions such as cancer relative to other developed countries, but higher mortality in circulatory and respiratory diseases. People in the U.S. have higher rates of survival after serious events like a heart attack or stroke, but more people die from cardiovascular disease. There are multiple reasons which explain why the U.S. has better outcomes for serious conditions, finances are a factor. Preventive care in the U.S. simply doesn’t pay, whereas specialty care and surgery can be lucrative. Most drugs for heart disease are generic, creating little incentive to invest in new medicines. Payment for remote chronic-disease monitoring is often limited to specific sites. And though the supply of primary care physicians is limited, specialists earn 1.5 times as much as primary care doctors. To improve the health of the general population, payment for primary care should be increased and alternative types of providers like pharmacists, who can help manage medication, should also be included.

Insurers are waiving costs for COVID-19 testing and treatment, and policies to reduce patient cost sharing for cardiovascular disease prevention and treatment should be expanded with the same urgency. Consumer costs have become the number-one concern and barrier to care, even for serious conditions like diabetes. One wonders how many people would have been better able to control the chronic conditions that put them at increased risk from COVID-19, if costs and deductibles for preventive care had been waived in the years leading to the pandemic?

People get their health care from multiple places including urgent care. Yet even within the same clinic, getting a complete picture can require a clunky patchwork of reports. Laws and regulations for data sharing and privacy differ between states. Federal standards were never established. As a result, very few patients have a full health record over time showing what treatment they have taken and what worked. Moving urgently to establish national standards for sharing and privacy allows for better disease management and it also helps to detect and monitor for viral outbreaks in the future.

We are doomed to high mortality and steep economic costs in future pandemics if we do not address the weaknesses in our management of chronic diseases. Retaining and expanding regulatory flexibility for telemedicine, changing financial incentives to encourage primary care treatment and collecting and sharing data will help improve health today. While we can’t predict the next virus, we can make meaningful policy changes now to foster a healthier population and a health system better able to cope with a pandemic.

Kirsten Axelsen is a visiting scholar with the American Enterprise Institute and a health care consultant with clients that include biopharmaceutical companies. Deborah Gordon is the author of “The Health Care Consumer’s Manifesto” and an adviser to health care and consumer service companies.