Cardio Care Health Services Need to Protect Vulnerable Patients During Heatwaves: ESC Report

A European Society of Cardiology report highlights how health services need to protect vulnerable patients during heatwaves. The report brings together all the existing research on how to prevent deaths and hospitalizations during heatwaves in people with different forms of cardiovascular disease.

Sophia Antipolis/France – A major new report from the European Society of Cardiology (ESC) sets out how health services need to protect vulnerable patients during heatwaves.

The report by a group of international experts was recently published in the European Heart Journal and brings together all the existing research on how to prevent deaths and hospitalizations during heatwaves in people with different forms of cardiovascular disease.

It details the need for hospital surge capacity during heatwaves, proactive home healthcare to monitor patients and provide cooling resources – such as fans, suitable storage for medication and watching out for signs of dehydration and overhydration in vulnerable patients.

Dr Georgia Chaseling from the University of Sydney, Australia, is the author of the report. She said: “We already know that extreme heat is not simply a matter of discomfort; it places considerable stress on the cardiovascular system and increases the risk of illness and death. But understanding the problem is only the first step. Doctors and other healthcare professionals need practical guidance on what they can do to protect their patients. In this report we translate the scientific evidence into practical advice that healthcare professionals can use before, during and after periods of extreme heat.”

The report has been published on behalf of the Association of Cardiovascular Nursing & Allied Professions, the Association for Acute Cardiovascular Care, the European Association of Preventive Cardiology, the Heart Failure Association, and the European Heart Rhythm Association (EHRA) of the ESC, the ESC Council on Hypertension, the ESC Council on Stroke and the ESC Working Group on Cardiovascular Pharmacotherapy.

It covers the entire pathway of patient care: identifying patients who are vulnerable, preparing them for extreme heat, managing medication, advising on hydration and cooling, monitoring patients during hot weather, adapting cardiac rehabilitation and exercise and continuing to monitor patients following a heatwave.

The report argues that extreme heat must become part of routine cardiovascular disease prevention and management. Dr Chaseling explained: “We need to know who is vulnerable before periods of extreme heat occur, to discuss individual heat-management plans with them and consider how their illness, medication, hydration needs and living circumstances may influence their risk. Heat preparedness should not begin when a patient presents to an emergency department during a heatwave. It should start much earlier, as part of anticipatory cardiovascular care.”

The authors say that extreme heat can increase demand on emergency departments, hospitals, primary care, home care and social services. Healthcare systems therefore need heat action plans, adequate surge capacity and resilient infrastructure. Proactive outreach is needed to reach vulnerable people who may be socially isolated or have limited access to cooling. All this will require coordination between healthcare providers, emergency services, public health agencies and local authorities.

The report also provides more specific recommendations for different cardiovascular populations, for example:

• In patients with heart failure, clinicians should monitor hydration, weight, electrolytes and medication use carefully.

• In patients with arrhythmias, particular attention should be given to changes in the body’s salt and mineral balance, hydration, and symptoms such as palpitations, dizziness and excessive fatigue.

• For people with hypertension, home blood pressure monitoring and prevention of heat-related hypotension and falls become particularly important.

Co-author, Professor Philip Moons from University of Leuven, Belgium said: “Ultimately, our aim is to make preparedness for extreme heat part of routine cardiovascular care. As heat extremes become more frequent and intense, we should not wait until a heatwave occurs to start thinking about how to protect our patients.

“For patients and their families, the most important message is that the cardiovascular risks associated with extreme heat are, at least partly, preventable. People with cardiovascular disease and their families need to recognize that hot weather may require changes in their usual routines and closer attention to hydration and cooling, and to blood pressure and heart rate. They should also know when symptoms such as dizziness, confusion, worsening breathlessness or palpitations require medical attention. Importantly, patients should not stop or change their cardiovascular medication on their own because of hot weather.”

The authors say more research is needed on why some patients seem to be more vulnerable to the heat than others. They also say that most of the research on the impact of heat on common medications comes from studies conducted in young, healthy individuals, rather than typical patients who can be older, frailer and have other health conditions.

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