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.