May 4, 2020
Cardiovascular Societies Outline a Framework for Resuming Cardiovascular Procedures and Diagnostic Tests
May 4, 2020—The American College of Cardiology (ACC) announced the publication of a document issued by ACC and other North American cardiovascular societies outlining a framework for ethically and safely reintroducing invasive cardiovascular procedures and diagnostic tests after the initial peak of the COVID-19 pandemic. The document is available online in the Journal of the American College of Cardiology.
ACC President Athena Poppas, MD, an author of the document, commented in the announcement, “Unprecedented times call for unprecedented collaboration, and a collaborative approach will be essential to mitigate the ongoing morbidity and mortality associated with untreated cardiovascular disease. It is essential that we work together to ensure cardiovascular disease patients are safely cared for during this pandemic and that we don’t allow for a new crisis of undiagnosed, untreated, or worsening cardiovascular disease to occur in the aftermath of this pandemic.”
As noted in the ACC announcement, during the COVID-19 pandemic, hospitals and practices have attempted to defer and replace critical procedures to diagnose and treat heart disease with intensified triage and management of patients on waiting lists. However, many patients with untreated cardiovascular disease are at an increased risk of adverse outcomes, and delays in the treatment of patients with confirmed cardiovascular disease can be detrimental. Also, reduced access to diagnostic testing can lead to a high burden of undiagnosed cardiovascular disease that will further delay time to treatment. Because cardiovascular disease is the leading cause of death in women and men worldwide, these patients need prioritization as health care systems return to normal capacity.
The North American cardiovascular societies' outline for how to reintroduce regular cardiovascular care in a progressive manner with appropriate safeguards includes the following three areas that must be considered:
- Ethical considerations that include maximizing benefits by prioritizing procedures that will ensure the most lives or life years are saved over those that benefit fewer people to a lesser degree, ensuring fairness in how cases are treated, ensuring proportionality so that the risk of further postponing treatment is weighed against exacerbating the spread and maintaining consistency in reintroduction across populations regardless of ability to pay and assuring health equity.
- Collaboration between regional public health officials, health authorities, and cardiovascular care providers to manage the dynamic balance between the provision of essential cardiovascular care and responding to future fluctuations in COVID-19 infections and hospital admissions.
- Protection of patients and health care workers through regions having the necessary critical care capacity, personal protective equipment, and trained staff available, and a transparent plan for testing and retesting potential patients and health care workers for COVID-19. Strategies for social distancing between patients and health care workers should also be considered, including virtual preprocedural clinics, virtual consenting for procedures and diagnostic tests, and minimizing the number of health care workers in physical contact with any given patient.
The North American cardiovascular societies represented on the document include ACC, American Heart Association, Canadian Cardiovascular Society, Canadian Association of Interventional Cardiology, Society for Cardiovascular Angiography and Interventions, Heart Valve Society, American Society of Echocardiography, Society of Thoracic Surgeons, Heart Rhythm Society, Society of Cardiovascular Computed Tomography, American Society of Nuclear Cardiology, Society of Nuclear Medicine and Molecular Imaging, Society for Cardiovascular Magnetic Resonance, Society of Nuclear Medicine, Canadian Heart Failure Society, and the Canadian Society of Cardiac Surgeons.