Clinical guidance for COVID-19 cardiovascular care: ACC advice for cardiology teams

Re-thinking the risk benefit of some cardiovascular procedures in the COVID-19 pandemic environment is advised by the American College of Cardiology in newly published supplementary guidelines

Among the recommendations in its COVID-19 Clinical Guidance For the Cardiovascular Care Team is that clinical leadership may need to assess the risk-benefit ratio of acute MI intervention vs nosocomial infection risk given the limited data on primary PCI benefit for type-2-MI from acute viral illness.

The guidance, based on best currently available published information and expert evaluation, notes that case fatality rates are highest for COVID-19 patients with cardiovascular comorbidities such as cardiovascular disease (CFR 10.5%) hypertension ( CFR 6.0%),and diabetes (7.3%).

They also note that acute cardiac complications have been reported in many cases of COVID-19.

“ In a recent case report on 138 hospitalised COVID-19 patients, 16.7% of patients developed arrhythmia and 7.2% experienced acute cardiac injury, in addition to other COVID-19 related complications,” the guidance states.

The ACC also warns that classic symptoms and presentation of acute MI may be overshadowed in the context of COVID-19, resulting in underdiagnosis

And it advises that for patients with heart failure or volume overload conditions, copious fluid administration for viral infection should be used cautiously and carefully monitored.

The ACC document can be found here.

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