Clinical guidance for cardiology teams
ACC Clinical Bulletin COVID-19 Clinical Guidance for Cardiovascular Teams
(Adopted from a guidance published by American College of Cardiology on 06/03/2020. The situation will change very quickly and the information below may become obsolete.)
To best serve your patients, protect yourself first!
• The overall case fatality rate (CFR) of COVID-19 remains low at 2.3%, with data indicating lower overall mortality in China outside of the outbreak epicenter in Hubei. In the rest of the world, CFRs ranges between 0.5% in South Korea and 2.7% in Iran. This is situation on 06.03.2020; the information is only provisional and likely to change.
• More than 80% of infected patients experience mild symptoms and recover without intensive medical support.
• Morbidity and mortality increase significantly with age, rising to 8.0% among patients 70-79 and 14.8% in patients over 80.
• Patients with underlying comorbidities are at higher risk of contracting the virus have a worse prognosis. 25% - 50% of COVID-19 patients have underlying medical problems.
• According to a recent report, 16.7% of hospitalized patients developed arrhythmia and 7.2% experienced acute cardiac injury, in addition to other COVID-19 related complications.
• Make plans for quickly identifying and isolating cardiac patients with relevant symptoms from other patients, including in the ambulatory setting.
• It is reasonable to advise all cardiac patients of the potential increased risk and to encourage additional, reasonable precautions.
• It is important for cardiac patients to remain current with vaccinations, including the pneumococcal vaccine given the increased risk of secondary bacterial infection with COVID-19. Cardiac patients should be vaccinated against influenza in accordance with current guidelines.
• In areas with active COVID-19 outbreaks, it may be reasonable to substitute clinic appointments for telephonic or telehealth consultations for stable cardiac patients to avoid possible nosocomial COVID-19 infection.
• It is reasonable to triage COVID-19 patients according to underlying cardiovascular, diabetic, respiratory, renal, oncological, or other comorbid conditions for prioritized treatment.
• Medical professionals are cautioned that classic symptoms and presentation of myocardial infarction may be masked in the context of COVID-19.
• Fluid administration for viral infection in patients with heart failure should be used cautiously and carefully monitored.
• General immunological health remains important for both medical professionals and patients, including eating well, sleeping and managing stress.
• Frequent transmission of COVID-19 to medical professionals suggests that usual infectious disease mitigation precautions are insufficient and medical professionals in outbreak areas must be prepared to adopt personal protection measures.
• Medical professionals with limited experience and/or training in personal protective equipment (PPE) should be trained as soon as possible
• Protocols should be developed for the management of myocardial infarction in the context of a COVID-19 outbreak. Particular emphasis should be placed on acute PCI and CABG, including protocols to limit the number of staff in the catheterization labs and operating theatres to a required minimum, use enhanced personal protection, and assess post-procedural sterilization sufficiency.