Heart failure-related hospitalisation and management during the COVID-19 pandemic: a reflection. Letter regarding the article 'The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic'.

We read with interest the report by Bromage et al. describing a significant decline in acute heart failure‐related admissions to a well‐reputed heart failure unit in London, during the current COVID‐19 pandemic. They rightly point out that a similar reduction has been noted in the admission rates of patients presenting with acute coronary syndromes in northern Italy. Locally, in the northwest of England, where the peak of the pandemic was delayed by a couple of weeks compared to London, we have witnessed similar trends with regard to a decline in acute hospital admissions with cardiovascular pathologies including heart failure. These findings have corroborated with an observation by the Nuffield Trust which report 52% fewer attendances in the major accident and emergency departments in London during the month of April 2020, compared to the same period last year. Similar figures were recorded in other regions in the UK including the northwest, too. The King's Fund (UK) raised a concern that in parallel to the declining hospital admission rates, there has been a concurrent rise in the number of people dying at home, with approximately 80% of these extra deaths being unrelated to COVID‐19. It is plausible that a proportion of this additional mortality is related to cardiovascular disorders including heart failure. According to a letter from the England's chief medical officer addressed to general practitioners, patients with heart failure were considered to be at an increased risk of developing severe illness from COVID‐19 and were advised to be ‘particularly stringent in following social distancing measures’. In our opinion, the UK government's strategy to prevent the National Health Service (NHS) from getting overwhelmed appeared to have worked well in keeping the pressure off health services; however, it might have been mis‐interpreted by many that the NHS was not open for any essential non‐COVID business. Although, as authors highlight, the heart failure services have been running normally during the pandemic period, an apparent reluctance in accepting hospital admission, possibly due to a genuine desire not to add extra stress on the health care institutions or a fear of picking up the contagion, seems to be the key reason behind a decline in acute heart failure‐related hospitalisation in UK. Hindsight is a great teacher, on reflection, we wonder whether we could have been more proactive in reaching out to our chronic heart failure patients during the pandemic. Enhanced remote clinical monitoring utilising telephone consultations and novel digital health solutions with a view to offering guidance regarding symptom control, an early detection of decompensation and early instigation of goal‐directed therapy could have provided a robust tele‐health framework for heart failure patients, during these difficult times.