Patients with cardiovascular disease, respiratory disease, cancer and diabetes are at increased risk for contracting COVID-19 and have a worse prognosis, said the American College of Cardiology in a clinical bulletin released March 6.
More than 80 percent of patients who contract the coronavirus have mild symptoms and recover without difficulty. However, age and pre-existing disease increase the morbidity and mortality rates significantly. As many as 50 percent of COVID-19 patients have and underlying medical condition. The fatality rate due to COVID-19 is low (2.3%) in the general population, but roughly triples in patients with hypertension (6%) or diabetes (7.3%), and more than quadruples in patients with cardiovascular disease (10.5%).
Cardiac complications also are common among COVID-19 patient populations, including arrythmia, acute cardiac injury, acute onset heart failure, myocardial infarction, myocarditis and cardiac arrest, but it is not yet known how the presence of underlying cardiac disease impacts the rate of these complications. Physicians should be aware that the classic symptoms of acute myocardial infarction (AMI) may be masked by COVID-19, resulting in underdiagnosis.
Physicians should advise all patients of the potential for increased risk and encourage reasonable precautions, such as keeping current on all vaccinations including pneumonia and influenza. Sleeping, eating and managing stress can help boost immune health in both patients and health care providers.
The bulletin also emphasizes that everyday infectious disease mitigation precautions are now considered insufficient in areas of outbreak and outlines some steps for preparedness of hospitals and providers who manage cardiac patients. These guidelines include training or re-training cardiac teams on using personal protective equipment; rehearsal of protocols for the diagnosis, triage and isolation of COVID-19 in cardiovascular patients; development of protocols for management of AMI in patients with or without a COVID-19 diagnosis; and revised catheterization lab protocols to help limit personnel and improve post-procedural sterility.
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