European Society of Cardiology COVID-19 guidance launched

European Society of Cardiology (ESC) guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic is published today in the European Heart Journal.

This guidance brought together a large number of key opinion leaders at the outset of the pandemic. The advice was first published on the ESC website to be regularly updated, and is now provided as a journal publication.

The two-part document provides practical information and advice to help clinicians diagnose and manage cardiovascular disease in patients with COVID-19.

Part one includes:

• The impact of cardiovascular comorbidities on the epidemiology of COVID-19 noting that:
  • Cardiovascular conditions are common in patients with COVID-19.
  • The presence of cardiovascular disease is associated with severe COVID-19 and higher mortality.
  • Cardiovascular risk factors are linked with severe COVID-19 and higher mortality.
• Summary of the cardiovascular manifestations of COVID-19:
  • Myocardial injury, arrhythmias, heart failure, vascular dysfunction, and thromboembolic disease are a consequence of severe infection.
  • Long-term cardiovascular manifestations of COVID-19 are unclear, so careful follow-up is needed.

• How to diagnose cardiovascular conditions in patients with the infection:
  • Covering the clinical presentation (e.g. chest pain, breathlessness), electrocardiogram (ECG), relevant cardiac biomarkers, and imaging modalities (when to perform and how to do it safely).

Part two includes:

• Management and treatment pathways for common cardiovascular conditions such as:
  • Diagnostic pathways and treatment algorithms for patients with suspected acute coronary syndromes.
  • Diagnosis and management of patients with chronic coronary syndromes
  • Advice on the management of patients with heart failure, valvular heart disease, arterial hypertension, acute pulmonary embolism, and arrhythmias.
  • Follow-up via tele-health.
• Treatment of SARS-CoV-2 Infection in patients with cardiovascular diseases including:
  • Maintenance of cardiovascular medications.
  • Drug–drug interactions, particularly regarding potential proarrhythmic properties.

• Patient information such as:
  • How to reduce the risk of transmission, maintain a healthy lifestyle, and manage cardiovascular disease.

The authors note that the papers summarize current knowledge and guidance: "The recommendations are mainly the result of observations and personal experience from healthcare providers [in Europe]. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities."