Cardiovascular Care Delivery During the Second Wave of COVID-19 in CanadaHospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in health care delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatically increased wait times for diagnostic tests and cardiovascular procedures, as well as associated increased cardiovascular morbidity and mortality. In the wake of the demonstrated ability to rapidly create critical care and hospital ward capacity, we advocate a different approach during the second and possible subsequent COVID-19 pandemic waves.
Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual CareCardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting.
Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System ResponseThe COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined.
Use of Renin-Angiotensin System Blockers During the COVID-19 Pandemic: Early Guidance and Evolving EvidenceThe COVID-19 pandemic invoked the need for prompt guidance and rapid research to address emerging clinical questions. In response to early theoretical concerns regarding the use of renin-angiotensin system (RAS) blockers, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and angiotensin receptor–neprilysin inhibitors (ARNIs) during the COVID-19 pandemic, the Canadian Cardiovascular Society (CCS) and Canadian Heart Failure Society (CHFS) issued guidance to continue these therapies among patients with heart failure and hypertension.