Cardiovascular Disease (CVD) in the COVID-19 Context
Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.
This tool has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for patients living with Cardiovascular Disease (CVD). While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.
Seek support: If you need support providing the best care possible for your patients, you can consult specialists via OTN eConsult.
Key takeaway
Patients with CVD are not more likely to acquire COVID-19, but they do appear to be at a greater risk for developing severe COVID-19 if infected (J Med Virol, May 22; Int J Public Health, May 25, 2020).
Click on the sections below to get started:
What's new, what's changed
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Screening
For patients with known heart failure, see the CCS virtual assessment guide to differentiate between COVID-19 and heart failure exacerbations.
Management
Ensure patients do not put themselves at further risk of CVD exacerbations by avoiding care.
Connect patients with remote monitoring and management supports.
Putting it into practice
- Limit routine blood work unless absolutely necessary, particularly for older adults (≥ 65 years) (Canadian Cardiovascular Society COVID-19 Rapid Response Task Force, April 15, 2020).
- Conduct regular follow-up (e.g. every 4 weeks) virtually or by phone with patients who have had cardiac procedures postponed and encourage patients to report any escalation of symptoms (Canadian Cardiovascular Society COVID-19 Rapid Response Task Force, April 15, 2020).
- Encourage patients to visit the ER if they experience symptoms or signs suggestive of acute coronary syndrome (Canadian Cardiovascular Society COVID-19 Rapid Response Task Force, April 15, 2020).
- Consider enrolling patients in OTN’s free, six-month, Telehomecare program that links patients with heart failure to Registered Nurses providing remote monitoring and intensive health coaching.
Treatment
Review patients’ cardiovascular medications.
Putting it into practice
- Consider SADMANS rules for medications that may be temporarily stopped, but do not discontinue ACE/ARBs to reduce the risk for COVID-19 (see Emerging evidence: Asymptomatic shedding, paediatric symptoms and Rx research > Medication misconceptions: COVID-19 and ACE inhibitors/ARBs for information).
- Consider switching appropriate patients from warfarin to direct oral anticoagulants to limit INR monitoring.
Resources
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
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Acknowledgement and legal
The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach.
They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
Clinical Working Group
A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:
• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP
In addition to our clinical working group the CEP also obtained feedback from others, including:
• Arun Radhakrishnan, MSC, MD, CM, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH
Thank you to everyone who supported the development of this resource.
Conflict of interest
• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)
The Cardiovascular Disease (CVD) in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Cardiovascular Disease (CVD) in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).
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