As a response to the Coronavirus/Covid-19 outbreak, many medical associations and organizations have released statements specifically related to treatment for cardiovascular patients.

These resources provide credible and trustworthy information. Many if not most, speak to the need for more detailed research and data, to help guide us as we develop new standards of practice to ensure optimal care based on clinical practice rather than speculation.
 

The best strategies to prevent contracting COVID-19 are:
  • Wear a mask in public places
  • Social distancing - stay at least 6 feet away from other people
  • Wash your hands frequently - with warm soapy water for at least 30 seconds
  • Avoid crowds, confined and poorly ventilated spaces.

Questions About COVID-19 Vaccination

02 April, 2021 - Heart.org

 

Wondering which shot to get, when, and why? Find answers to those questions and more.

Which vaccines are being used in the U.S.?

So far three vaccines(link opens in new window), named for the companies that make them, are available in the United States:

 

Links to CDC vaccine info pages are provided for convenience only, they are not an endorsement of any company, product or service.

- Pfizer-BioNTech 
- Moderna
- Johnson & Johnson Janssen

This is an extensive article with excellent information for the general answering many questions and concerns. It is well worth the time to review the full article.

  • Also discussed:
    How do the vaccines work?
    Which vaccine should I get?
    How long will the vaccine protect me?
    How much will I have to pay for COVID-19 vaccination?
    How should I get ready for my vaccination appointment? What should I expect?
    When should I get the second COVID-19 shot?
    Can I get my COVID-19 vaccination at the same time as another vaccine?
    Help! I want to get vaccinated but I can't get an appointment.
    What are the most common side effects of vaccination?
    Are there serious side effects from the vaccine?
    Can I catch COVID-19 from the vaccine?
    Could vaccination cause me to test positive for COVID-19?
    Will the vaccine keep me from spreading COVID-19 to others?
    When am I considered “fully vaccinated”?
    Once I'm fully protected, can I go back to living my life the way I did before the pandemic?
    What's a “vaccine passport”?
    Can children get vaccinated for COVID-19?
    Should I get the vaccine if I'm pregnant or breastfeeding?
    Should I get the vaccine if I have a history of heart disease or stroke?
    Does vaccination affect other medical procedures I might have? I've heard mammograms might be a problem.
    I have allergies. Should I get a COVID-19 vaccine?
    What if I have some other underlying condition?
    If I already had COVID-19, do I still need to be vaccinated?
    Wouldn't I be better protected against COVID-19 in the future if I just got infected naturally, instead of getting vaccinated?
    What does “herd immunity” mean?
    What are virus “variants”? Can the current COVID-19 vaccines protect against them?
    What is “emergency use authorization”?
    Where can I find out more about the COVID-19 vaccines?
    How can I take part in a clinical trial of a COVID-19 vaccine or treatment?

 

Clinical outcome of COVID-19 in patients with adult congenital heart disease

15 March, 2021 - Heart.BMJ

Abstract:
 
Aims: Patients with adult congenital heart disease (ACHD) are a potentially vulnerable patient cohort in case of COVID-19. Some cardiac defects may be associated with a poor COVID-19 outcome. Risk estimation in ACHD is currently based on expert opinion. The aim of this study was to collect clinical outcome data and to identify risk factors for a complicated course of COVID-19 in patients with ACHD.
 
Methods: Twenty-five ACHD centres in nine European countries participated in the study. Consecutive patients with ACHD diagnosed with COVID-19 presenting to one of the participating centres between 27 March and 6 June 2020 were included. A complicated disease course was defined as hospitalisation for COVID-19 requiring non-invasive or invasive ventilation and/or inotropic support, or a fatal outcome.
 
Results: Of 105 patients with a mean age of 38±13 years (58% women), 13 had a complicated disease course, of whom 5 died. In univariable analysis, age (OR 1.3, 95% CI 1.1 to 1.7, per 5 years), ≥2 comorbidities (OR 7.1, 95% CI 2.1 to 24.5), body mass index of >25 kg/m2 (OR 7.2, 95% CI 1.9 to 28.3) and cyanotic heart disease (OR 13.2, 95% CI 2.5 to 68.4) were associated with a complicated disease course. In a multivariable logistic regression model, cyanotic heart disease was the most important predictor (OR 60.0, 95% CI 7.6 to 474.0).
 
Conclusions: Among patients with ACHD, general risk factors (age, obesity and multiple comorbidities) are associated with an increased risk of complicated COVID-19 course. Congenital cardiac defects at particularly high risk were cyanotic lesions, including unrepaired cyanotic defects or Eisenmenger syndrome...

 

This is an open-access article distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

AstraZeneca Vaccine Unfairly Under Fire Over Clot Risk?

15 March, 2021 - MedPageToday
 
Thromboembolic and bleeding risk has been cited by a number of countries in halting use of AstraZeneca's COVID-19 vaccine, but the company and health agencies argued against a causal link.
 
Denmark and Norway were first to stop administering AstraZeneca's vaccine last week over isolated cases of bleeding, blood clots, and low platelet count. Others followed.
 
In a statement released Sunday, AstraZeneca said it has seen no evidence of increased risk of pulmonary embolism, deep vein thrombosis, or thrombocytopenia either overall or for specific age groups, genders, batches, or particular countries.
 
It said there had been 15 deep vein thrombosis (DVT) events and 22 pulmonary embolism (PE) cases reported among the some 17 million recipients of its vaccine in the European Union and U.K. as of March 8.
 
"This is much lower than would be expected to occur naturally in a general population of this size and is similar across other licensed COVID-19 vaccines," it said...

Everything We Thought We Knew Was Wrong

11 March, 2021 - Medscape

 

It's been 1 year since the day the World Health Organization declared that a new, fast-spreading coronavirus had caused a pandemic.
 
"WHO has been assessing this outbreak around the clock, and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction," Director General Tedros Adhanom Ghebreyesus told reporters listening around the world.
 
"We have therefore made the assessment that COVID-19 can be characterized as a pandemic," he said. "We have rung the alarm bell loud and clear."
 
By that time, COVID-19 had been known to the world for little more than 2 months. In the US, we could see it coming, but hadn't yet felt its full impact in our day-to-day lives.
 
Americans had watched in horror and trepidation as China and other Asian countries grappled with their outbreaks. By March 11, Wuhan, the city where the virus first emerged, was already more than halfway through its nearly 3-month lockdown...

COVID-19 and its impact on the cardiovascular system

08 March, 2021 - NIH - National Library of Medicine

 

Hypertension, pre-existing cardiovascular disease (CVD) and acute myocardial injury are significant risk factors for increased in-hospital mortality in patients with COVID-19. The findings were published in the journal Open Heart.
 
Researchers analysed a cohort of 498 patients (mean age, 67.4 years; 62.2% male) admitted to the Imperial College Healthcare NHS Trust between 7 March 2020 and 7 April 2020 with COVID-19-related symptoms.
 
At admission, 53.4 per cent of patients had hypertension, 40.2 per cent had diabetes, 31.7 per cent had hyperlipidaemia, 19.7 per cent had chronic kidney disease and 13.9 per cent had a history of coronary artery disease.
 
Patients who died of COVID-19 had a higher incidence of pre-existing CVD (78.6% vs 57.6%; P<.001) and hypertension (68.2% vs 46.8%; P=.001) than those who remained alive. Acute myocardial injury was seen in 43.2 per cent of patients. The likelihood of mortality was higher in those with myocardial injury than those without (47.4% vs 18.4%; P<.001).
 
In the adjusted analyses, myocardial injury (OR, 2.39; P=.005) and hypertension (OR, 1.88; P=.0049) were identified as key predictors of in-hospital mortality in patients with COVID-19.
 
According to the authors, the identification of factors associated with increased mortality may help in risk stratification of patients. They also emphasise that a high incidence of acute myocardial injury warrants increased cardiac team involvement in the care of patients.
 
View the abstract on NIH - National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/33723014/

Current Key Questions on COVID-19 and Cardiovascular Disease

02 March, 2021 - ACC - American College of Cardiology

 

What are the considerations for cardiomyopathy and heart failure in COVID-19?

Category: CARDIAC COMPLICATIONS OF COVIDPatient Type: COVID+Prevalence: MODERATELY COMMONPrincipal Guidance: Cardiac dysfunction is moderately common among hospitalized patients with COVID-19 and confers a worse prognosis; focused imaging and other cardiac diagnostics are warranted to guide differential management; clinical management remains supportive although experimental strategies continue to be evaluated.Author: Ashwin Ravichandran, MD, MPH, FACC; Joel Schilling, MD, PhD; Stacy Mandras, MD, FACCSQC Approval Date: February 16, 2020

What are the considerations for cardiomyopathy and heart failure in COVID-19?

Category: CARDIAC COMPLICATIONS OF COVIDPatient Type: COVID+Prevalence: MODERATELY COMMONPrincipal Guidance: Cardiac dysfunction is moderately common among hospitalized patients with COVID-19 and confers a worse prognosis; focused imaging and other cardiac diagnostics are warranted to guide differential management; clinical management remains supportive although experimental strategies continue to be evaluated.Author: Ashwin Ravichandran, MD, MPH, FACC; Joel Schilling, MD, PhD; Stacy Mandras, MD, FACCSQC Approval Date: February 16, 2020

What are considerations for long-term management of COVID-19-related myocarditis?

Category: CARDIAC COMPLICATIONS OF COVIDPatient Type: COVID+Prevalence: UNKNOWNPrincipal Guidance: Clinical and imaging evidence indicates myocarditis may be present in patients recovering from COVID, though the prevalence and clinical significance remains uncertain; diagnosis should be reserved for patients exhibiting syndromic myocarditis and treatment should be in accordance with current guidelines for heart failure and arrhythmia; return to sport or strenuous exercise should be delayed for three to six months post diagnosis, conditional on nominal diagnostic findings.Author: Jeffrey J. Hsu, MD, PhD, FACCSQC Approval Date: February 16, 2020

What is home-based cardiac rehabilitation, and how could it be used during the COVID-19 pandemic?

Category: CV THERAPEUTICSPatient Type: COVID+/COVID-Prevalence: COMMONPrincipal Guidance: Home-based cardiac rehabilitation (CR) has demonstrated comparable benefits to traditional hospital-based programs and may serve as a viable alternative during COVID-19; reimbursement for formal home-based CR programs is now more prevalent than early in the pandemic; the role of home-based CR for recovering COVID patients with cardiac sequelae is currently uncertain, at minimum requiring thorough physician evaluation before referral.Author: Brittain Heindl, MD; Vera Bittner, MD, MSPH, FACCSQC Approval Date: February 16, 2020

How best to use telehealth to manage CV conditions during the pandemic?

Category: CV THERAPEUTICSPatient Type: COVID+/COVID-/CVPrevalence: COMMONPrincipal Guidance: Telehealth is now a permanent part of cardiovascular medicine, augmenting but not displacing traditional care delivery; effective telemedicine requires similar attention to workflow design and management, team-based care, and longitudinal follow-up as in-person care, adapted to the advantages and limitations of virtual patient interaction; expect rapid change as the provider, payer and technology ecosystem all adapt to increased telehealth demand.Author: Ami Bhatt, MD, FACCSQC Approval Date: February 16, 2020

What are thrombosis risk and management considerations in COVID-19?

Category: COVID THERAPEUTICSPatient Type: COVID+Prevalence: MODERATELY COMMONPrincipal Guidance: Thromboembolism risk in COVID-19 patients is sufficient to recommend pharmacological venous thromboembolism (VTE) prophylaxis in all hospitalized patients unless contraindicated; VTE prophylaxis is generally not recommended in non-hospitalized and post-discharge COVID-19 populations given the much lower documented risk of VTE, unless otherwise clinically warranted; multiple randomized trials are studying the effect of therapeutic-level anticoagulant dosing in hospitalized patients, which may alter guidance in the future.Author: Geoffrey D. Barnes, MD, MSc, FACCSQC Approval Date: February 16, 2020

How best to manage CV operations (e.g., EP procedures, interventional cardiology procedures, etc.) during the pandemic?

Category: CV OPERATIONSPatient Type: CV PATIENTSPrevalence: COMMONPrincipal Guidance: Under pressure to preserve inpatient capacity while protecting medical staff and non-COVID patients, many hospitals and health systems have adopted or expanded same-day discharge (SDD) for common cardiovascular procedures; SDD can also decrease costs and improve patient satisfaction; careful pre-planning and program management are essential to preserve quality and capture operational efficiencies.Authors: Ginger Biesbrock, PA-C, MPH, MPAS, FACCSQC Approval Date: February 16, 2020

Do you have questions about a medical case or need help understanding treatment plans and options?

Health & Patient Advocacy | Medical Case Review

Medical Expert Witness

Dalawari Medical Services - Medical Consulting

Click here to Contact Us via email  or  Call + (804)-500-0685

Jasdeep Dalawari MD

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.

Leave a Comment