Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

• Published in: Journal of the American College of Cardiology Vol. 75; no. 18; pp. 2352 - 2371
• Main Authors: Driggin, Elissa, Madhavan, Mahesh V., Bikdeli, Behnood, Chuich, Taylor, Laracy, Justin, Biondi-Zoccai, Giuseppe, Brown, Tyler S., Der Nigoghossian, Caroline, Zidar, David A., Haythe, Jennifer, Brodie, Daniel, Beckman, Joshua A., Kirtane, Ajay J., Stone, Gregg W., Krumholz, Harlan M., Parikh, Sahil A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 12.05.2020; by the American College of Cardiology Foundation. Published by Elsevier
• Subjects: Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - virology; Betacoronavirus; Cardiovascular; cardiovascular therapy; coronavirus; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; COVID-19; Health Personnel; health system; Heart Diseases - complications; Heart Diseases - virology; Humans; Myocarditis - complications; Myocarditis - virology; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Risk Factors; SARS-CoV-2; The Present and Future; Triage; ECMO; cardiovascular therapy; PPE; RNA; CI; health system; coronavirus; COVID-19; CVD; ACE2; ARB; SARS-CoV-2; CV; ICU; MI; ARDS; ribonucleic acid; myocardial infarction; angiotensin receptor blocker; severe acute respiratory syndrome coronavirus 2; angiotensin-converting enzyme 2; extracorporeal membrane oxygenation; intensive care unit; cardiovascular disease; personal protective equipment; cardiovascular; coronavirus disease 2019; acute respiratory distress syndrome; confidence interval
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2020.03.031

The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission. We hereby review the peer-reviewed and pre-print reports pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems. [Display omitted] •Patients with pre-existing CVD appear to have worse outcomes with COVID-19.•CV complications include biomarker elevations, myocarditis, heart failure, and venous thromboembolism, which may be exacerbated by delays in care.•Therapies under investigation for COVID-19 may have significant drug-drug interactions with CV medications.•Health care workers and health systems should take measures to ensure safety while providing high-quality care for COVID-19 patients.