Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings

Dorairaj Prabhakaran, Pablo Perel, Ambuj Roy, Kavita Singh, Lana Raspail, José Rocha Faria-Neto, Samuel S Gidding, Dike Ojji, Ferdous Hakim, L Kristin Newby, Janina Stępińska, Carolyn S P Lam, Modou Jobe, Sarah Kraus, Eduardo Chuquiure-Valenzuela, Daniel Piñeiro, Kay-Tee Khaw, Ehete Bahiru, Amitava Banerjee, Jagat Narula, Fausto J Pinto, David A Wood, Karen Sliwa, Dorairaj Prabhakaran, Pablo Perel, Ambuj Roy, Kavita Singh, Lana Raspail, José Rocha Faria-Neto, Samuel S Gidding, Dike Ojji, Ferdous Hakim, L Kristin Newby, Janina Stępińska, Carolyn S P Lam, Modou Jobe, Sarah Kraus, Eduardo Chuquiure-Valenzuela, Daniel Piñeiro, Kay-Tee Khaw, Ehete Bahiru, Amitava Banerjee, Jagat Narula, Fausto J Pinto, David A Wood, Karen Sliwa

Abstract

In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.

Keywords: COVID-19; cardiovascular disease; coronavirus; low income countries; low resource settings; middle income countries.

Conflict of interest statement

The authors have no competing interests to declare.

Copyright: © 2020 The Author(s).

Figures

Figure 1
Figure 1
Global Map of COVID-19 pandemic by region.
Figure 2
Figure 2
Outcomes of acute chest pain [35]. Figure 2 adapted from ACC guideline Diagnosing Type 2 Myocardial Infarction [35].
Figure 3
Figure 3
Diagnosis and management of myocardial injury in COVID-19 patients. Legend: ACE, angiotensin converting enzyme; BNP, brain natriuretic peptide; CPAP, continuous positive airway pressure; ECG, electrocardiogram; EMB; endomyocardial biopsy; HCU, high care unit; hs-TnT, high sensitivity troponin T; ICU, intensive care unit; JVP, jugular venous pressure; MRA, mineralocorticoid receptor antagonists; MV, mitral valve; RA, right atrium; RV, right ventricle; TV, tricuspid valve.

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