ACC statement on CV considerations for COVID-19 vaccine allocation
The ACC has recently released a health policy statement on CVD considerations and COVID-19 vaccine prioritization. The statement includes a proposed schema that outlines CV clinical risk considerations within the broader context of overall risk considerations, which include exposure, disparities, health care access, advanced age, and multimorbidity. In addition, it offers specific guidance on the incorporation of CV risk into vaccine allocation decisions.
In the statement, specific contributions of CV conditions to COVID-19 infection and severity are reviewed. CV conditions that should be considered at high risk for adverse outcomes associated with COVID-19 include: hypertension, diabetes, obesity, ASCVD, cardiac dysrhythmia, HF, prior heart transplant, pulmonary hypertension and adult congenital heart disease. In addition, patients with CVD in combination with noncardiac comorbidities, such as CKD, an immunocompromised status, or hypercoagulability amongst others, are also considered increased risks for morbidity and mortality in COVID-19.
The ACC recommend that those individuals with relatively higher CV risk should be prioritized for COVID-19 vaccines over individuals with lower CV risk. Examples include:
- Patients with poorly controlled hypertension (>140/90 mm Hg), insulin-dependent diabetes, or diabetes with poor glycemic control (HbA1c >10%) compared to those who are medically optimized.
- Patients with morbid obesity (BMI >40 kg/m²) compared to those who are obese (BMI 30-40 kg/m²) or overweight (BMI 25-29 kg/m²).
- Individuals with high-risk or symptomatic ASCVD, including CAD or PAD, compared to individuals with asymptomatic or fully revascularized disease.
- Patients with poorly tolerated AF or atrial flutter as well as those with a history of VT or VF previously requiring ICD therapy and/or anti-arrhythmic medication.
- Patients with HF (NYHA functional class III or IV) and those requiring hospitalization or an urgent visit due to worsening compared to those patients who are well-compensated with optimal therapy and infrequently hospitalized for HF.
- Patients with HF who are considered or listed for heart transplantation (because of their advanced decompensated heart).
- Patients who have had a transplantation (because of their immunosuppressed status).
- Patients with pulmonary hypertension (PH) who are decompensated and being considered or listed for lung transplantation, followed by those with moderate to severe PH.
- Patients with advanced adult congenital heart disease (ACHD) should be prioritized.