Table 1.

Mechanisms for potential effects of COVID-19 pandemic on subsequent cardiovascular mortality and morbidity

Impacts on CV morbidity or mortality	Direct effects of COVID-19	Delayed/foregone health care	Social and economic impacts
Primary impact (days-weeks)	⋄Myocarditis ⋄Acute coronary syndrome ⋄Microvascular thromboses ⋄Arrhythmias ⋄Septic/stress-induced cardiomyopathy ⋄Pericarditis	⋄Out-of-hospital cardiac arrests ⋄Delayed presentation of MI/stroke
Secondary impact (weeks-months)		⋄Heart failure/structural heart complications caused by missed or late presentations of MI ⋄Shortages of important CV risk-reducing medications ⋄“Infodemic” misinformation ⋄Reduced adherence with CV risk reducing therapy as an unintended consequence of 30-day refill restrictions ⋄ Reduced secondary cardiovascular prevention caused by the following: o Foregone outpatient visits o Shift to virtual visits o Curtailment of routine outpatient laboratory monitoring	⋄Income loss and unemployment ⋄Physical inactivity ⋄Social isolation, depression, and anxiety
Tertiary impact (months-years)	⋄Unknown: May include heart failure, myocardial fibrosis, scar-related arrhythmia, etc. ⋄COVID-induced diabetes effect on CV risk	⋄ Reduced primary and secondary cardiovascular prevention due to: o Foregone outpatient visits o Shift to virtual visits o Curtailment of routine outpatient laboratory monitoring	⋄Income loss and unemployment ⋄Physical inactivity ⋄Social isolation, depression, and anxiety

CV, cardiovascular; MI, myocardial infarction.