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European Society of Cardiology (ESC) guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic has been published today in the European Heart Journal.

The guidance was developed by a large number of key opinion leaders, led by Professor Colin Baigent, Director of the Medical Research Council Population Health Research Unit at the University of Oxford, and Professor Stephan Windecker, from the University of Bern.

The guidance was first published on the ESC website, and is now published as a two-part document that provides practical information and advice to help clinicians diagnose and manage cardiovascular disease in patients with COVID-19.

Professor Baigent, joint lead author of the guidelines said: ‘At the start of the COVID-19 pandemic, there was an urgent need to provide advice for clinicians dealing with cardiovascular disease and a new disease that was little understood. By pooling expertise and experience from across Europe, we have been able to develop and publish these extensive guidelines which enable clinicians to provide the best possible care to patients with cardiovascular disease and COVID-19.’  

Part one includes:

  • The impact of cardiovascular comorbidities on the epidemiology of COVID-19 noting that:
    • Cardiovascular conditions are common in patients with COVID-19.
    • The presence of cardiovascular disease is associated with severe COVID-19 and higher mortality.
    • Cardiovascular risk factors are linked with severe COVID-19 and higher mortality.
  • A summary of the cardiovascular manifestations of COVID-19:
    • Myocardial injury, arrhythmias, heart failure, vascular dysfunction, and thromboembolic disease are a consequence of severe infection.
    • Long-term cardiovascular manifestations of COVID-19 are unclear, so careful follow-up is needed.
  • How to diagnose cardiovascular conditions in patients with COVID-19:
    • Covering clinical presentation (such as chest pain, or breathlessness), electrocardiogram, relevant cardiac biomarkers, and imaging modalities (when to perform them and how to do them safely).

Part two includes:

  • Management and treatment pathways for common cardiovascular conditions such as:
    • Diagnostic pathways and treatment algorithms for patients with suspected acute coronary syndromes.
    • Diagnosis and management of patients with chronic coronary syndromes
    • Advice on the management of patients with heart failure, valvular heart disease, arterial hypertension, acute pulmonary embolism, and arrhythmias.
    • Follow-up via tele-health.
  • Treatment of SARS-CoV-2 infection in patients with cardiovascular diseases including:
    • Maintenance of cardiovascular medications.
    • Drug–drug interactions, particularly regarding potential proarrhythmic properties.
  • Patient information such as:
    • How to reduce the risk of transmission, maintain a healthy lifestyle, and manage cardiovascular disease.

The authors note that the papers summarise current knowledge and guidance: ‘The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.’