Caution in prescribing off-label medicines, and deferring coronary angiography in stable patients with COVID-19 and suspected myocardial infarction, are two of the key recommendations issued in the consensus statement on cardiovascular disease (CVD) and COVID-19.
The Heart Foundation has summarised the advice to cardiac health services in a consensus statement endorsed by the Heart Foundation, Cardiac Society of Australia and New Zealand (CSANZ), and the High Blood Pressure Research Council of Australia.
“This statement is the first of its kind to be released in Australia and summarises the available data on COVID-19 and cardiovascular disease,” said co-author, Heart Foundation Chief Medical Adviser, cardiologist Professor Garry Jennings.
“In addition to highlighting the vulnerability of cardiac patients to COVID-19 complications, the statement advises hospitals on how to adapt their cardiac services during the pandemic to minimise the risk of transmission to healthcare professionals and patients while continuing to deliver care to those who need it most.”
Professor Jennings said the statement reflects input from Australian and New Zealand experts in key areas of cardiology care and public health service, as well as a wide literature search and review of consensus statements from international cardiology societies.
Key recommendations from the consensus statement published in the Medical Journal of Australia include:
Clinicians should take caution around medicines currently being investigated for COVID-19 (chloroquine, hydroxychloroquine, azithromycin and ritonavir/lopinavir) due to possible cardiac toxicity.
All health services need to review elective procedures in order to increase hospital capacity and conserve valuable personal protection equipment (PPE). Rapid discharge strategies should be instigated including for PCI and NSTEMI admissions.
Stable angina, troponin-negative chest pain, non-life-threatening arrhythmias or cardiac diagnoses without clinical instability may be managed in an outpatient setting. Patients with COVID-19 and suspected MI should be managed conservatively, with invasive procedures deferred until after COVID-19 recovery.
Minimise risk to health personnel by reserving transesophageal echo (TOE) and stress testing to situations where other investigations have been exhausted.
Consider using telehealth or digital health platforms for all suitable outpatient consultations, cardiac rehabilitation programs and nurse-led clinics.