Conclusions
HF incidence, prevalence, and undertreatment will grow as a result of new COVID-19-related heart disease. ECMO should be reserved for highly selected cases of COVID-19 with a reasonable probability of recovery. Special considerations are needed for patients with advanced HF, including those supported by durable LVADs.

COVID-19

Coronavirus disease 2019 (COVID‐19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The disease is usually mild, although occasionally severe with patients presenting with pneumonia, acute respiratory distress syndrome (ARDS), and circulatory shock (CS).[1] In a recent report, 26.1% of 138 COVID-19 patients needed to be admitted to the intensive care unit (ICU), of which 61.1% were suffering from ARDS. The heterogeneity of responses between individual patients is marked indicating host characteristics promote progression of the disease with a range of different presentations from mild symptoms to multiorgan failure.
Although the clinical symptoms of the disease are predominantly respiratory, direct and indirect involvement of other organs is common, with the cardiovascular (CV) system being particularly affected. Moreover, pre-existing conditions, largely linked to CV disease (CVD), increase the risk of severe outcomes of the infection. A large Chinese study analysing data of 44,672 confirmed COVID‐19 cases revealed 12.8% had hypertension, 5.3% diabetes, and 4.2% CVD.[2] A further study of 5,700 patients from the USA reported a similar message that hypertension (56.6%), obesity (41.7%), diabetes (33.8%), CAD (11.1%) and congestive heart failure (6.9%) were common comorbidities in patients with COVID‐19.[3] Older patients are more likely to experience ICU admission, mechanical ventilation, or death compared with younger patients, and males seem to be more susceptible to COVID-19-related complications.
COVID-19 has resulted in substantial policy change and strain on existing healthcare infrastructure. Many healthcare providers have had to scale down outpatient services and defer elective cardiac procedures and operations with re-deployment of the workforce to help manage the pandemic. The long-term clinical impact of scaling down outpatient activity, reduced access to investigations, and cancellation of routine procedures will have consequences beyond the pandemic. In addition, the perceived risk of being exposed to COVID-19 has led to a delay in presentation of acute cardiac emergencies with a likelihood of increasing cardiac mortality and morbidity. Until now, no specific treatment has been recommended for COVID-19, although extracorporeal membrane oxygenation (ECMO), providing effective respiratory or cardiac support, can be regarded as a rescue therapy for severe ARDS.