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Triage considerations for patients referred for structural heart disease intervention during the COVID-19 pandemic:
Pinak B Shah1,2, Frederick G P Welt1,3, Ehtisham Mahmud4,5
1American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, District of Columbia, USA.
Insights
The COVID-19 pandemic created challenges for patients needing structural heart interventions. New guidelines help decide when to perform procedures like transcatheter aortic valve replacement, balancing risks during the pandemic.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare, leading to the postponement of elective procedures.
- Patients with valvular and structural heart disease faced delayed care, increasing risks of heart failure (CHF) and death.
- Triage decisions became complex, balancing hospital exposure risks against procedural delay risks.
Purpose of the Study:
- To provide guidelines for triaging patients requiring structural heart interventions during the COVID-19 pandemic.
- To establish a framework for deciding on the appropriateness of interventions amidst the ongoing pandemic.
- To address specific triage considerations for transcatheter aortic valve replacement and percutaneous mitral valve repair.
Main Methods:
- Review of current literature and clinical experience.
- Development of a decision-making framework for structural heart interventions.
- Discussion of procedural modifications and team function during the pandemic.
Main Results:
- The study proposes a structured approach to patient triage for structural heart disease interventions.
- It outlines criteria for proceeding with procedures like TAVR and MitraClip, considering pandemic-related risks.
- Recommendations are provided for managing structural heart disease teams and procedural safety.
Conclusions:
- Effective triage is crucial for managing structural heart disease patients during the COVID-19 pandemic.
- Guidelines can help clinicians make informed decisions about timely interventions.
- Adapting procedural practices and team function is essential for patient safety and care continuity.
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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