ACC issues coronavirus COVID-19 clinical guidance for CV care team

ACC President Richard J Kovacs announced the release of an updated ACC Clinical Bulletin on coronavirus COVID-19 Clinical Guidance for the CV care team. This bulletin contains an overview of COVID-19, information on acute cardiac complications of COVID-19 and implications for CV patients. It also provides clinical guidance and recommendations for cardiac-specific preparedness. It is intended as a supplement to relevant guidance from the Centers for Disease Control and Prevention, state, local health authorities and institution’s infectious disease containment, mitigation, and response plan.

Patients with underlying comorbid conditions have a increased risk for contracting COVID-19 and a worse prognosis. An estimated 25% to 50% of COVID-19 patients present with underlying conditions. Case fatality rate for comorbid patients is substantially higher than the average population (2.3%), with an estimated rate of 6.0% in those with hypertension, 7.3% in diabetes patients, and 10.5% in CVD patients.

A case study of 138 hospitalized COVID-19 patients reported that 16.7% of patients developed arrhythmia and 7.2% had acute cardiac injury, in addition to other COVID-19 related complications. Other reports indicate cases of acute onset HF, MI, myocarditis and cardiac arrest (may be precipitated by higher cardiometabolic demand). Reports do not describe cardiac complication in CVD naïve patients (vs. comorbid patients).

Recommendations include:

• Available plans for quick identification and isolation of CV patients with COVID-19 symptoms from other patients.
• It is reasonable to advise CV patients of potential increased risk and encourage additional, reasonable precautions (in accordance with CDC guidance).
• Patients with CVD should remain current with vaccinations.
• In areas with COVID-19 outbreaks, it may be reasonable to substitute in-person routine visits for telephonic or telehealth visits in stable CVD patients. Planning for emergency telehealth protocols should start now.
• Copious fluid administration for viral infection should be used carefully and monitored for HF patient or those with volume overload conditions.
• Eating well, sleeping and managing stress are important issues to remain general immunological health for both providers and patients.
• Specific protocols should be developed for the management of AMI in context of a COVID-19 outbreak.

Source: ACC Clinical Bulletin, March 6, 2020