Guidelines for Balancing Priorities in Structural Heart Disease During the COVID-19 Pandemic

Area of Science:

• Cardiology
• Interventional Cardiology
• Public Health

Background:

• The COVID-19 pandemic necessitated postponing elective procedures in hospitals.
• Existing consensus statements on elective structural heart disease interventions during the pandemic were insufficient.
• There was a need for practical, multidisciplinary guidelines for managing these cases.

Purpose of the Study:

• To propose urgent, practical, and implementable guidelines for structural heart disease interventions during the COVID-19 pandemic.
• To provide a framework for managing practices during pandemic surge and peak phases.
• To address the ambiguity of "elective" in the context of structural heart disease.

Main Methods:

• Development of general principles applicable to all structural heart disease interventions.
• Inclusion of specific guidance for transcatheter aortic valve replacement and MitraClip procedures, varying by pandemic phase.
• Emphasis on tracking outcomes, "healthcare distancing," resource preservation, and shared decision-making.

Main Results:

• Proposed guidelines focus on patient safety and resource allocation.
• Recommendations differentiate management strategies for surge and peak pandemic phases.
• Specific guidance is provided for high-risk patients and those requiring inpatient care for discharge facilitation.

Conclusions:

• The proposed guidelines offer a practical framework for managing structural heart disease interventions during pandemics.
• Prioritizing patient safety and equitable resource rationing is crucial.
• Multidisciplinary collaboration and adaptive strategies are essential for navigating healthcare crises.