ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2—care pathways, treatment, and follow-up

Abstract

Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. Methods and results A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. Conclusion This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. 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.

Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes

“…While patients with NSTEMI are suggested to be managed according to risk stratification (very high risk—treated as patients with STEMI, high risk, intermediate risk, and low risk), this indication does not apply to patients with STEMI, to guarantee timely reperfusion. According to the ESC document, all patients with STEMI should be managed as COVID-19 positive, in the absence of previous SARS-CoV-2 testing, to ensure the safety of healthcare personnel ( 57 , 58 ).…”

Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

“…This review will not deal with PE and COVID-19, for which the reader is referred to the dedicated European Society of Cardiology (ESC) consensus document. 2 …”

Sex Differences in Incidence, Clinical Characteristics and Outcomes in Children and Young Adults Hospitalized for Clinically Suspected Myocarditis in the Last Ten Years—Data from the MYO-PL Nationwide Database

“…Results of our study are particularly important and should be discussed in the light of a recent Severe Acute Respiratory Syndrome Coronavirus-2 pandemic. At the moment, the consensus has been reached that it is not a cardiotropic virus and acute myocarditis represented by the viral presence and infiltrates in the myocardium with myocardial injury is rarely observed in the course of Coronavirus Disease 2019 (COVID-19) [ 15 , 23 ]. In individuals with so far uninvestigated predispositions the virus can be a trigger for an immune reaction, leading to immune-mediated myocarditis.…”