Cardiovascular Collateral Damages at the Time of COVID-19
On March 13th, 2020, the Québec provincial government announced an extended lockdown over all sectors of the economy to face the COVID-19 pandemic.1 Supportive programs were instituted to insure implementation of effective social-distancing measures.2 Hospitals were asked to postpone elective and semielective procedures to spare personal protective equipment.3 The general population respected the request for confinement and stayed home.Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care
Cardiac 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.First Documentation of Persistent SARS-Cov-2 Infection Presenting With Late Acute Severe Myocarditis
A 64-year-old man presented with severe myocarditis 6 weeks after an initial almost asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection. He was found to have a persistent positive swab. Mechanisms explaining myocardial injury in patients with COVID-19 remains unclear, but this case suggests that severe acute myocarditis can develop in the late phase of COVID-19 infection, even after a symptom-free interval.The Next Wave of Health Care Strain Related to COVID-19: Heart Failure Patients Coming Back in Force—We Must Not Fail Them
In preparation for the expected wave of critically ill patients, the initial COVID-19 response focused on minimizing in-person healthcare encounters and reallocating resources to patients with COVID-19. Strict physical distancing to flatten the curve, coupled with dramatic downscaling of services, have thus far been successful in avoiding a calamitous surge of COVID-19 in most Canadian jurisdictions. As we recalibrate our approach to healthcare delivery, recognizing that COVID-19 will have a drawn out and sustained impact on healthcare, attention is turning towards addressing the backlog of procedures and surgeries.Strategic Cardiac Catheterization Lab Staffing in the Era of COVID-19: The Pod Initiative
The COVID-19 pandemic affected cardiovascular programs across Canada, with multiple professional organizations recommending deferral of all elective and semielective procedures to reduce exposures in the hospital setting and to save critical care capacity. Few recommendations directly addressed health care unit integrity.Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response
The 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 Evidence
The 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.Echocardiographic Findings in Patients With COVID-19 Pneumonia
The aim of this study was to characterize the echocardiographic phenotype of patients with COVID-19 pneumonia and its relation to biomarkers. Seventy-four patients (59 ± 13 years old, 78% male) admitted with COVID-19 were included after referral for transthoracic echocardiography as part of routine care. A level 1 British Society of Echocardiography transthoracic echocardiography was used to assess chamber size and function, valvular disease, and likelihood of pulmonary hypertension. The chief abnormalities were right ventricle (RV) dilatation (41%) and RV dysfunction (27%).Surveillance for COVID-19 in Cardiac Inpatients: Containing COVID-19 in a Specialized Cardiac Centre
We read with interest the article by Cosentino et al., who described a triage pathway for patients with acute coronary syndrome (ACS) during a COVID-19 outbreak.1 However, although COVID-19 might manifest as ACS, other cardiac complications can also be associated with SARS-CoV-2 infection2; for instance, respiratory viruses can cause heart failure or myocarditis. Because a small percentage might be presymptomatic,3 this makes detection even more challenging. Some form of risk stratification is necessary to prioritize patients for COVID-19 testing.Family Engagement in the Cardiovascular Intensive Care Unit in the COVID-19 Era
The COVID-19 pandemic has caused an abrupt shift in the way care is delivered in cardiovascular intensive care units (CICUs). One example of this drastic change has been the limitations placed on family visitation. In many hospitals across Canada and beyond, a strict "no visitor" policy has been implemented. Governments and hospital administrators have instituted this policy to prevent the spread of infection and preserve protective equipment. However, physical distancing may lead to social isolation and emotional distress for both patients and their families.Decrease and Delay in Hospitalization for Acute Coronary Syndromes During the 2020 SARS-CoV-2 Pandemic
The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients’ responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020.The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias.Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic
The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization.Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock.Lung Ultrasound for Cardiologists in the Time of COVID-19
Lung ultrasound (LUS) is a point-of-care ultrasound technique used for its portability, widespread availability, and ability to provide real-time diagnostic information and procedural guidance. LUS outperforms lung auscultation and chest X-ray, and it is an alternative to chest computed tomography in selected cases. Cardiologists may enhance their physical and echocardiographic examination with the addition of LUS. We present a practical guide to LUS, including device selection, scanning, findings, and interpretation.Late STEMI and NSTEMI Patients’ Emergency Calling in COVID-19 Outbreak
The highly contagious coronavirus that causes COVID-19 disease is affecting daily clinical practice. The anticipated fast growth in cases has led to development of a regional restructuring model to preserve time-sensitive pathologies in northern Italy. On this way, the Lombardy Region Government built up a big hub-and-spoke model to converge treatment of acute coronary syndrome (ACS) in 13 dedicated centres active 24/7 in the region, implementing availability of intensive care unit beds in general hospitals converted to COVID-19 treatment.Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease
Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make physical activity challenging. We objectively measured the impact of the COVID-19 pandemic on physical activity, continuously measured by Fitbit step counts, in children with CHD. Step counts were markedly lower in late March and early April 2020, compared with 2019 and early March 2020.Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership
The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality (1–3). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited resources. Most invasive cardiovascular (CV) procedures and diagnostic tests have been deferred with North American CV societies advocating for intensified triage and management of patients on waiting lists (4). Unfortunately, patients with untreated CV disease are at increased risk of adverse outcomes (5).COVID-19—Where Have All the STEMIs Gone?
The COVID-19 pandemic has required acute and long-term services to accommodate surges in hospital admissions. Cardiovascular care has experienced challenges to primary percutaneous coronary intervention (PPCI) from safety (personal protective equipment), staffing (health care worker infection rates), and patient welfare perspectives. Recently, an approximately 40% reduction in ST-segment-elevation myocardial infarction (STEMI) presentations for PPCI has been reported during the COVID-19 crisis.1 Reduced STEMI admissions could relate to altered patient behaviour, disrupted care pathways, or altered cardiovascular risk factors pertaining to partial or complete lockdown conditions during the pandemic (Fig. 1).Ramping Up the Delivery of Cardiac Surgery During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons
The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions.COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage
The coronavirus disease 2019 (COVID-19) pandemic has resulted in large-scale social distancing, working from home, prohibiting large group gatherings,1 and staying at home.2 These public health measures have been shown to be effective in the influenza pandemic of 19183 and continue to hold a place in today’s scenario. Social distancing requires one to maintain a distance of at least 2 m or 6 feet between individuals in public spaces4 whereas stay at home orders require an individual to remain confined to one’s home with the provision to leave for essential errands (ie, groceries, medicine, and health care).A Focus on COVID-19: Fast and Accurate Information to Guide Management for Pandemic-Related Issues in Cardiac Patients
The COVID-19 pandemic is in “full flower,” causing the shedding of many tears for the innocents who have suffered and died, despair over incomes lost and businesses endangered, and spilling of much ink (some of it useful). This new reality has set in much faster than we have been able to absorb it and adjust.Considerations for Scaling Down Fetal Echocardiography During the COVID-19 Pandemic
In the context of the COVID-19 pandemic, institutions performing fetal echocardiography (FE) are weighing the risks and benefits of reducing the number of FE to free up resources and limit nonessential visits to hospitals and clinics. These decisions must be made rapidly, often without a solid knowledge base. As of the first week of April 2020, strategies adopted by Canadian institutions varied considerably, with some significantly scaling down the rate of FE and others maintaining the pace as before the pandemic.Management and Treatment of COVID-19: The Chinese Experience
With more than 1,800,000 cases and 110,000 deaths globally, COVID-19 is one of worst infectious disease outbreaks in history. This paper provides a critical review of the available evidence regarding the lessons learned from the Chinese experience with COVID-19 prevention and management. The steps that have led to a near disappearance of new cases in China included rapid sequencing of the virus to establish testing kits, which allowed tracking of infected persons in and out of Wuhan. In addition, aggressive quarantine measures included the complete isolation of Wuhan and then later Hubei Province and the rest of the country, as well as closure of all schools and nonessential businesses.An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19 Outbreak: Initial Experience Under Real-World Suboptimal Conditions
Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system.
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