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CV Considerations for Patients, Healthcare Workers, and Health Systems During the COVID-19 Pandemic
TAKE-HOME MESSAGE
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The authors review the available literature regarding the cardiovascular considerations of the current COVID-19 pandemic. Patients with preexisting cardiovascular disease (CVD) plus COVID-19 have an increased risk of severe illness and death compared with patients without CVD. In addition, COVID-19 appears to have multiple cardiovascular complications, such as acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Current therapies under review may impact the cardiovascular system. Healthcare workers are especially vulnerable to infection or to becoming host or vectors of virus transmission.
- The cardiovascular community has a key role to play in the management of patients affected by COVID-19 as well as in the continued management of patients with established CVD who are at high-risk for severe infection.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and preexisting cardiovascular disease (CVD) have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become host or vectors of virus transmission. We hereby review the peer-reviewed and preprint literature pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
Additional Info
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COVID-19: Considerations for Cardiac Care
In a daily situation report I just received, I note that across 13 hospitals there are 986 patients under investigation for coronavirus disease 19 (COVID-19) and 77 confirmed with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Of these, 43 are inpatients and 14 are ventilated. Wow… four months ago no one saw this coming, and now we are in the midst of a global pandemic. COVID-19 has changed everything and catapulted cardiologists into the forefront of hospital-based response. Two recent articles are of acute interest to all cardiologists and any other clinicians caring for patients with cardiac conditions.
A quick review, provided by Xiong and colleagues,1 outlines the very basics of epidemiology, underlying cardiovascular disease (CVD) risk factors for worsened COVID-19 outcomes, the cardiovascular complications of infection, and long-term sequelae. For a much deeper and well-referenced dive (but one that I would suggest as essential), invest a few minutes in the comprehensive review by Driggen et al.2 The epidemiology, pathogenesis, and clinical features of SARS-CoV-2 are succinctly presented. The presence of risk factors for CVD and existing CVD are associated with increased COVID-19 morbidity and mortality. Moreover, significant cardiovascular sequelae are commonly reported with SARS-CoV-2 infection and include myocardial ischemia and myocarditis, risk for plaque rupture, arrhythmia, cardiac arrest, cardiomyopathy, heart failure, cardiogenic and mixed shock, venous thromboembolic disease, and confusing symptomology (e.g., chest pain and electrocardiographic changes with normal coronary arteries on catheterization).
The cardiac considerations and complications of the pharmaceutical interventions currently under evaluation or in compassionate use are summarized and their potential interactions with common cardiovascular agents are discussed. For additional and up-to-date information on medications that may be in use for COVID-19 patients, however, I suggest an excellent resource, “Assessment of Evidence for COVID-19-Related Treatments,” provided by the American Society of Health-System Pharmacists at: https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx.
Finally, the authors provide an extensive overview regarding self-protection during aerosol producing interventions, such as cardiopulmonary resuscitation, and approaches to lowering risk of transmission to healthcare workers and patients. It’s a new world out there and COVID-19 is likely to be with us for at least several months. As CVD risk factors contribute to COVID-19 hospitalizations and COVID-19 results in cardiovascular complications, cardiologists will increasingly feel the press of this pandemic. Accordingly, thoughtful preparation is a key component of navigating this threat.
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