In this Health Policy Statement, the American College of Cardiology Solution Set Oversight Committee reviews the impact of cardiovascular risk factors and comorbidities on coronavirus disease 2019 (COVID-19) outcomes and proposes a vaccine allocation schema based on cardiovascular risk. The following are key points to remember:

1. A vaccine policy with high benefit would be one that prioritizes individuals at highest risk of adverse outcomes related to COVID-19.
2. Current Phase 1c guidance by the Centers for Disease Control and Prevention specifies that patients 16-64 years of age with high-risk medical conditions such as cardiovascular comorbidities should receive the vaccine; albeit without further delineation of risk.
3. Hypertension, diabetes mellitus, and obesity are the most common comorbidities (15-50% in prevalence) in patients hospitalized with COVID-19 and are associated with increased risk of mortality.
4. Atherosclerotic disease and heart failure are also common (5-10%) and are risk factors for in-hospital death.
5. While data are more limited, pre-existing arrhythmias, congenital heart disease, prior heart transplant, or pulmonary hypertension also appear to confer increased risk of death.
6. The severity of these conditions and whether they are well controlled are strong determinants of their association with COVID-19–related outcomes.
7. Accordingly, the vaccine allocation schema proposes prioritizing patients with more advanced cardiovascular disease compared to those with well controlled cardiovascular conditions.
8. For example, patients with poor glycemic control, symptomatic atherosclerotic disease, or frequent arrhythmias should be prioritized over those with well optimized blood glucose, asymptomatic coronary artery disease, or stable arrhythmias.
9. Perspective: Although simple by design, the implementation of the current vaccine allocation strategy has been met with innumerable challenges across health care systems in the United States. Addition of a layer of high complexity to account for cardiovascular disease severity—which is poorly codified if at all in electronic medical records—would represent a daunting task.
10. Perspective: At the least, this Health Policy Statement equips health care providers with a reference document and approach to counsel cardiovascular patients regarding their risk for COVID-19–related outcomes and the need to undergo vaccination.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Transplant, Pulmonary Hypertension, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Hypertension

Keywords: Arrhythmias, Cardiac, Atherosclerosis, Blood Glucose, Cardiovascular Diseases, Coronavirus, COVID-19, Delivery of Health Care, Diabetes Mellitus, Electronic Health Records, Health Personnel, Health Policy, Heart Defects, Congenital, Heart Failure, Heart Transplantation, Hypertension, Hypertension, Pulmonary, Obesity, Primary Prevention, Risk Assessment, Risk Factors, Vaccination

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