COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)

Abstract

Up to one-third of COVID-19 patients admitted to intensive care develop an acute cardiomyopathy, which may represent myocarditis or stress cardiomyopathy. Further, while mortality in older patients with COVID-19 appears related to multi-organ failure complicating acute respiratory distress syndrome (ARDS), the cause of death in younger patients may be related to acute heart failure. Cardiac involvement needs to be considered early on in critically ill COVID-19 patients, and even after the acute respiratory phase is passing. This Statement presents a screening algorithm to better identify COVID-19 patients at risk for severe heart failure and circulatory collapse, while balancing the need to protect health care workers and preserve personal protective equipment (PPE). The significance of serum troponin levels and the role of telemetry and targeted transthoracic echocardiography (TTE) in patient investigation and management are addressed, as are fundamental considerations in the management of acute heart failure in COVID-19 patients.

COVID‐19: getting to the heart of the matter

“…However, most patients (78%) who presented with acute HF after COVID‐19 infection did not have a prior history of HF. Even though older age was a predictor of acute HF in this study, it is important to note that younger individuals are also at risk of developing HF following infection with COVID‐19 9 …”

“…The Cardiac Society of Australia and New Zealand released a position statement to help guide clinicians on the appropriate use and interpretation of the electrocardiogram, biomarkers and transthoracic echocardiogram (TTE) in hospitalized patients with COVID‐19 infection. In particular, a TTE should be reserved for those individuals with a single elevated high‐sensitivity troponin and abnormal electrocardiogram on presentation or those individuals with high‐sensitivity troponins that continue to rise or new‐onset tachyarrhythmias, even in the absence of overt HF symptoms 9 …”

Promising Therapy for Heart Failure in Patients with Severe COVID-19: Calming the Cytokine Storm

“…Early identification and timely treatment are beneficial for improving the prognosis of patients with COVID-19 and increasing the utility ratio of strained medical resources. The laboratory index of patients with COVID-19 who develop HF is consistent with acute cardiac injury in retrospective studies [ 36 ]; additionally, fatal outcomes in patients with COVID-19, particularly fulminant myocarditis, are consistent with increased levels of inflammatory indicators [ 39 , 83 ]. Thus, we propose that specific elevated cytokines and appreciably altered inflammatory biomarkers are early warning signals in at-risk patients that may forecast pathogenic conditions and a poor prognosis.…”

COVID-19 and Heart, Lung and Circulation: Riding the 2020 Waves of Change in Australia & New Zealand✰

“…Adaptive health care delivery models and resource allocation would be required throughout the health care system [ 1 ]. Subsequently, nine comprehensive CSANZ Position or Consensus Statements [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] and an Executive Summary of a tenth [ 16 ], were fast-tracked to on-line publication in Heart, Lung and Circulation . Designed as “living documents” that would be revised as needed (e.g., when more detailed information became available), each Statement comprehensively outlined the changed models of care with respect to different aspects of cardiovascular practice: acute heart failure and assessing the critically ill [ 7 ] assessing suspected acute coronary syndromes [ 8 ], interventional cardiology services delivery [ 9 ], echocardiography services [ 10 ], management of cardiac electrophysiology and cardiac implantable electronic devices [ 11 ], genetic heart diseases [ 12 ], paediatric and congenital heart disease [ 13 ], cardiac rehabilitation and secondary prevention [ 14 ], rural and remote cardiology [ 15 ], and cardiovascular nursing [ 16 ].…”