The American College of Cardiology together with other North American cardiovascular societies has issued a framework for ethically and safely reintroducing invasive cardiovascular procedures and diagnostic tests after the initial peak of the COVID-19 pandemic.

The document was published today in the Journal of the American College of Cardiology.

The COVID-19 pandemic has forced appropriate, but significant, restrictions on routine medical care, including invasive procedures to treat heart disease and diagnostic tests to diagnose heart disease.

Many hospitals and practices have attempted to defer and replace these critical procedures 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.

Cardiovascular disease is the leading cause of death in women and men worldwide and these patients need prioritization as health care systems return to normal capacity. In this document, North American cardiovascular societies outline how to reintroduce regular cardiovascular care in a progressive manner with appropriate safeguards.

The authors have outlined three areas that must be considered when reintroducing services, including:

• 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, ensuing proportionality so that the risk of further postponing treatment is weighed again 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 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 (PPE), and trained staff available, and a transparent plan for testing and re-testing 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 pre-procedural clinics, virtual consenting for procedures and diagnostic tests, and minimizing the number of health care workers in physical contact with any given patient.

"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," said Athena Poppas, MD, FACC, ACC president and one of the authors on the document.

"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."

North American Cardiovascular Societies represented on the document are: 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.

For more information and to download the summary guidance table and a slide set, visit ACC's COVID-19 Hub at ACC.org/COVID19.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Sports and Exercise Cardiology, Stable Ischemic Heart Disease, Valvular Heart Disease, Vascular Medicine, Anticoagulation Management and ACS, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Acute Heart Failure, Pulmonary Hypertension, Interventions and ACS, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Hypertension, Sleep Apnea, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology, Sports and Exercise and ECG and Stress Testing, Sports and Exercise and Imaging, Chronic Angina

Keywords: COVID-19, Coronavirus, Coronavirus Infections, Acute Coronary Syndrome, Anticoagulants, Arrhythmias, Cardiac, Cardiac Surgical Procedures, Metabolic Syndrome, Angina, Stable, Heart Defects, Congenital, Dyslipidemias, Geriatrics, Heart Failure, Angiography, Diagnostic Imaging, Pericarditis, Secondary Prevention, Hypertension, Pulmonary, Sleep Apnea Syndromes, Sports, Angina, Stable, Exercise Test, Heart Valve Diseases, Aneurysm

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