A group of North American cardiovascular societies released guidance today on the resumption of heart-related procedures in light of the COVID-19 pandemic.
The guidance, scheduled to be published in a future issue of the Journal of the American College of Cardiology, takes into account regional differences in the intensity of the outbreak.
Most invasive cardiovascular procedures and diagnostic tests have been deferred within North America, resulting in waiting lists for patients at increased risk of adverse outcomes, the groups said. Reduced access to diagnostic testing will lead to a high burden of undiagnosed cardiovascular disease that will further delay time to treatment, they added.
“Although there will be a myriad of competing demands from multiple disciplines, this risk warrants the prioritization of cardiovascular patients as healthcare systems return to normal capacity,” the societies concluded.
Here are some of their recommendations:
- Hospital-based cardiovascular teams must exchange establish active, up-to-date information on both the local status of the pandemic and the growing morbidity and mortality on cardiovascular procedure waiting lists.
- There should be a sustained reduction in the rate of new COVID-19 admissions and deaths as determined by local public health officials before procedures can resume. If COVID-19 admissions and deaths start to increase, most elective invasive procedures and tests should cease immediately.
- Routine screening of patients and healthcare workers for COVID-19.
- Careful use and monitoring of personal protective equipment (PPE) inventory to minimize the risk of shortages.
- An expectation of using the highest-level of PPE during emergency cardiovascular cases or for aerosol-generating medical procedures.
- Physical distancing efforts, including virtual pre-procedural clinics, virtual consenting for procedures and diagnostic tests, and minimizing the number of healthcare workers in physical contact with any given patient.
- Other strategies, such as greater use of minimally invasive procedures, if effective; shorter length of stay; less invasive tests; and alternative imaging.
“This consensus report provides harmonized guidance from North American cardiovascular societies,” the groups said in the article. “It provides an ethical framework with appropriate safeguards for the gradual reintroduction of invasive cardiovascular procedures and diagnostics tests after the initial peak of the COVID-19 pandemic. A collaborative approach will be essential to mitigate the ongoing morbidity and mortality associated with untreated cardiovascular disease.”