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Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the COVID-19 Pandemic:
Pinak B Shah1, Frederick G P Welt2, Ehtisham Mahmud3
1American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
This document provides guidelines for triaging patients with structural heart disease during the COVID-19 pandemic. It helps clinicians decide when to proceed with interventions like transcatheter aortic valve replacement despite pandemic risks.
Area of Science:
- Cardiology
- Public Health
Background:
- The COVID-19 pandemic has disrupted healthcare, delaying essential procedures for structural heart disease patients.
- Delayed interventions increase risks of heart failure (CHF) and mortality in these vulnerable patients.
- Triage decisions involve balancing procedural risks against the risks of delaying care during the pandemic.
Framework:
- Presents guidelines for triaging patients requiring structural heart interventions.
- Offers a decision-making framework for proceeding with interventions amidst the pandemic.
- Addresses specific interventions such as transcatheter aortic valve replacement and percutaneous mitral valve repair.
Implementation:
- Focuses on practical considerations for structural heart disease teams.
- Discusses procedural adaptations and safety measures during the pandemic.
- Aims to ensure timely and safe patient care in a challenging healthcare environment.
Implications:
- Facilitates informed decision-making for managing structural heart disease during health crises.
- Helps mitigate adverse cardiovascular outcomes in patients awaiting procedures.
- Supports the continued function of specialized heart teams during public health emergencies.
Abstract:
The coronavirus disease-2019 (COVID-19) pandemic has strained health care resources around the world, causing many institutions to curtail or stop elective procedures. This has resulted in an inability to care for patients with valvular and structural heart disease in a timely fashion, potentially placing these patients at increased risk for adverse cardiovascular complications, including CHF and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic against the risk of delaying a needed procedure. In this document, the authors suggest guidelines for how to triage patients in need of structural heart disease interventions and provide a framework for how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, the authors address the triage of patients in need of transcatheter aortic valve replacement and percutaneous mitral valve repair. The authors also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic.
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