4 key considerations for managing cardiovascular patients with or without COVID-19

As new therapies for COVID-19 are tested over the coming months, cardiovascular health professionals working to optimize outcomes must be mindful of the “intricate interplay” between cardiovascular disease, the novel coronavirus and emerging or repurposed drug therapies.

And they must remain so while simultaneously considering the concerns and views of healthcare workers, members of hospital/health system leadership and, not least, patients—whether the latter are infected or not.

That’s the view of a team of medical scholars who published a review paper online March 19 in the Journal of the American College of Cardiology.

“The cardiovascular community will play a key role in the management and treatment of patients affected by this disease, and in addition in providing continuity of care to noninfected patients with underlying cardiovascular disease,” write the team, which was co-led by corresponding author Sahil Parikh, MD, of Columbia University and the Cardiovascular Research Foundation in New York City.

Along the way to reaching their conclusions, the authors call attention to four aspects of cardiovascular and COVID-19 management that will be crucial to CV care while researchers race to curtail the pandemic.

1. CV societal leadership. Noting the cancellations of numerous medical conferences, including the ACC’s 2020 scientific sessions, the authors point out that replacement resources are being leveraged to fill the gap. These include the ACC Clinical Bulletin, which, the authors remind, provides a practical clinical summary about key implications and recommendations for CV care of COVID-19 patients.

The ACC and peer societies “agree that further data would be vital to inform decisions on adjusting regimens of [ACE inhibitors and angiotensin receptor blockers] in the setting of this outbreak,” Parikh and colleagues write. “Moving forward, these important CV societies among other large physician groups and health systems will be critical allies to advance the knowledge generation and CV care in patients infected with this virus.”

2. Preparing for hospital surges and prioritizing care for the critically ill. As the pandemic surges, hospitals may need to enact policies to thwart the “worried well” from drawing resources better reserved for severe and high-risk CV patients.

“Given concerns of hospitals exceeding capacity, specific protocols will need to be developed for the care of CV patients while preserving limited inpatient resources and minimizing provider and patient exposures,” the authors write. In addition, given the need for ICU beds after cardiac surgery, medical management or percutaneous interventional approaches “may need to be preferentially considered for urgent scenarios that cannot wait (e.g. percutaneous coronary intervention rather than coronary artery bypass graft surgery or transcatheter valve solutions rather than surgery) to minimize ICU bed utilization.”

3. Need for education. Caring for patients who have COVID-19 will have CV specialists closely collaborating with pulmonologists, infectious-disease experts, cardiologists, surgeons, pharmacists and hospital leadership, among others, the authors underscore.

“Optimal infection control and treatment strategies for COVID-19 should be shared with the entire healthcare community,” they write. “Accordingly, every effort must be made to provide clear and unambiguous information to patients and decision-makers, countering myths and false news which may generate panic or false optimism.”

4. Ethical challenges. “The unprecedented challenge represented by COVID-19 has brought novel and dramatic ethical dilemmas, ranging from policy issues (e.g. focusing on containment and mitigation vs. herd immunity), as well as clinical dilemmas (e.g. considering all patients alike vs triaging patients according to age, comorbidities and expected prognosis, similar to other catastrophic circumstances),” the authors write. “Close interaction between patient advocates, government officials and regulators, as well as physician groups, hospital administrators and other societal leaders will be essential to navigate these ethical challenges.”

Parikh et al. point to the difficult decision to cancel the ACC’s annual conference as an example of the “incisive leadership” needed to help mitigate the risks posed by COVID-19 to CV healthcare workers as well as the population at large.

They conclude that efficient use of resources, “including leveraging of the telehealth capabilities and optimal adherence to preventative population-wide and provider-level measures, will enable the transition from this critical period until the disease outbreak is contained.”

The ACC’s news division has posted a summary overview of the paper.