Cardiovascular disease and COVID ‐19: Australian and New Zealand consensus statement

Abstract

the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic. The presence of underlying cardiovascular disease (CVD) confers the highest mortality with COVID-19. Thus, patients with CVD must be considered a particularly at-risk population. [1][2][3][4][5] Community transmission, patient-to-patient transmission and health care worker infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are overwhelming health services worldwide. [4][5][6] High quality cardiac care must minimise risk of viral transmission to patients and health care workers. It should adapt resources in the context of reduced access to hospital beds and personal protective equipment (PPE). This consensus statement reviews and summarises data on SARS-CoV-2 infection in pre-existing CVD and acute cardiovascular manifestations of COVID-19, and makes recommendations for cardiac service provision during the pandemic. Development process for the recommendationsA group of CVD experts, drawn from the Cardiac Society of Australia and New Zealand (CSANZ), the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia, convened in March 2020. Key opinion leaders in cardiology, cardiothoracic surgery and public health with broad geographic representation were consulted. We searched major databases (EMBASE, MEDLINE and PubMed) to identify relevant systematic reviews, randomised controlled trials and clinical case series in English from January 2020 to 25 March 2020. As the majority of studies relating to COVID-19 and CVD at the time of writing were observational in nature, results must be interpreted with caution. Given data limitations, consensus documents produced by international cardiology societies from December 2019 to March 2020 were reviewed. [7][8][9] Experts from key areas (electrophysiology and pacing, interventional cardiology, imaging, cardiothoracic surgery, nursing, hypertension, prevention and rural) generated key recommendations from their respective councils and groups. In addition, social networking platforms (eg, WhatsApp) involving CSANZ board members, cardiology heads of department and key opinion leaders were used to identify relevant resources, guidance documents and protocols. An online living document was shared to facilitate wide input. The full draft underwent peer review by the listed authors as well as external experts in each subspecialty field of cardiology before agreement and acceptance of the final document. Pre-existing cardiovascular disease and COVID-19Patients with COVID-19 and pre-existing CVD are at increased risk of severe disease and death. [1][2][3][4][5] A meta-analysis of eight studies and over 46 000 patients in China reported that hypertension, diabetes and CVD were the most common comorbidities. 5 Baseline CVD conferred the highest odds of any comorbidity for developing severe versus mild COVID-19 (odds ratio [OR], 3.42; 95% CI, 1.88-6.22). Hypertension ...

Personal protective equipment and evidence‐based advice for surgical departments during COVID‐19

“…Hence, the number of surgical staff present within a healthcare facility should be minimized wherever possible. Allocating surgical staff to alternating ‘teams’ for staggered attendance within each department could prevent care from being adversely impacted in such a situation 38 . If any surgical staff member were to display any symptoms suspicious of COVID‐19, the staff member and all exposed contacts must self‐isolate according to both local and national guidelines 39 …”

COVID ‐19 safety: aerosol‐generating procedures and cardiothoracic surgery and anaesthesia — Australian and New Zealand consensus statement

“…If emergency surgery is required then patients should be risk assessed. It should be remembered that acute coronary syndrome is a common cardiac manifestation of COVID‐19 11. A statement from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand provides guidance on the management of such patients 11…”

“…It should be remembered that acute coronary syndrome is a common cardiac manifestation of COVID-19. 11 A statement from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand provides guidance on the management of such patients. 11 Data on the risk of COVID-19-positive patients undergoing cardiothoracic surgery are limited, although high peri-operative mortality is suggested.…”

“…11 A statement from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand provides guidance on the management of such patients. 11 Data on the risk of COVID-19-positive patients undergoing cardiothoracic surgery are limited, although high peri-operative mortality is suggested. A study from Wuhan in patients undergoing non-cardiac elective surgery during the incubation period of COVID-19 demonstrated a 44% intensive care requirement and 20% mortality.…”

Criticality of physical/social distancing, handwashing, respiratory hygiene and face‐masking during the COVID‐19 pandemic and beyond

“…Meanwhile, our understanding of the pathogenesis, prognosis, symptoms and case-fatality rate of COVID-19 is still limited but growing fast. [3][4][5][6][7][8][9][10][11] Outbreak of the COVID-19 pandemic inevitably led to realistic, mandatory restrictive countermeasures in many countries, causing uncertainty for millions of people with resultant unprecedented effects on economy and morale-importantly livelihood and job losses-which will require many years to recuperate. Thus, eliminating the ongoing impact of the pandemic on the social fabric, morale and psychosocial and economic well-being is critical.…”