ABSTRACT
There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial rise in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this manuscript, we review the direct impact of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect impacts of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic impacts on healthcare systems and particularly the care deficits caused (or exacerbated) by healthcare delayed or foregone during the COVID-19 pandemic. We review the consequences of (i) deferred/delayed acute care for urgent conditions, (ii) the shift to virtual provision of outpatient care, (iii) shortages of drugs and devices, and reduced access to (iv) diagnostic testing, (v) cardiac rehabilitation, and (vi) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.