Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week
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Christine J Chung1, Tamim M Nazif1, Mariusz Wolbinski1
1Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
Insights
Patients with structural heart disease face higher risks from coronavirus disease-2019 (COVID-19). These recommendations aim to guide treatment, minimize exposure, and conserve resources during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Patients with structural heart disease (SHD) have increased vulnerability to severe outcomes from coronavirus disease-2019 (COVID-19).
- The COVID-19 pandemic presents unique challenges for managing SHD patients, requiring adaptation of clinical practices.
- Existing clinical guidelines may not adequately address the complexities of SHD management during a pandemic.
Purpose of the Study:
- To develop crisis-driven recommendations for the management of structural heart disease patients during the COVID-19 pandemic.
- To ensure timely and appropriate care for SHD patients while minimizing healthcare-associated risks.
- To provide a framework for optimizing resource utilization in cardiology settings under pandemic-related constraints.
Main Methods:
- The recommendations were formulated based on the experiences of a heart team at a major COVID-19 epicenter.
- Considerations included patient risk stratification, modification of treatment pathways, and infection control measures.
- The approach focused on practical, reality-based strategies for clinical decision-making.
Main Results:
- The recommendations prioritize the safety of both patients and healthcare workers.
- Strategies aim to balance the urgent need for SHD treatment with the risks posed by COVID-19.
- The guidelines address the efficient allocation of limited healthcare resources.
Conclusions:
- These crisis-driven recommendations offer a practical approach for managing structural heart disease patients during the COVID-19 pandemic.
- Adapting clinical pathways is crucial for maintaining essential cardiovascular care amidst infectious disease outbreaks.
- Early experiences from epicenters can inform strategies for healthcare systems globally facing similar challenges.
Abstract:
Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.
