Heart failure and COVID-19

Abstract

Heart failure is a common disease state that can be encountered at different stages in the course of a COVID-19 patient presentation. New or existing heart failure in the setting of COVID-19 can present a set of unique challenges that can complicate presentation, management, and prognosis. A careful understanding of the hemodynamic and diagnostic implications is essential for appropriate triage and management of these patients. Abnormal cardiac biomarkers are common in COVID-19 and can stem from a variety of mechanisms that involve the viral entry itself through the ACE2 receptors, direct cardiac injury, increased thrombotic activity, stress cardiomyopathy, and among others. The cytokine storm observed in this pandemic can be a culprit in many of the observed mechanisms and presentations. A correct understanding of the two-way interaction between heart failure medications and the infection as well as the proposed COVID-19 medications and heart failure can result in optimal management. Guideline-directed medical therapy for heart failure should not be interrupted for theoretical concerns but rather based on tolerance and clinical presentation. Initiating specific cardiac or heart failure medications to prevent the infection or mitigate the disease is also not an evidence-based practice at this time. Heart failure patients on advanced therapies including those with heart transplantation will particularly benefit from involving the advanced heart failure team members in the overall management if they contract the virus.

Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study

“…However, AST can be elevated due to various extrahepatic causes, for example, myositis and cardiomyopathy, which have also been described in COVID-19 patients. 46 47 …”

Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

“…Second, SARS-CoV-2 infection has been associated with markedly elevated proinflammatory mediators and cytokine profile similar to the cytokine release syndrome [ 4 ]. Moreover, SARS-CoV-2 infection has been associated with direct myocardial injury that might worsen previous cardiac diseases such as CHF [ 3 , 35 ] and prevent achieving the higher hemodynamic demands associated with infection [ 4 , 36 ]. Finally, SARS-CoV-2 infection has been associated with angiotensin-converting enzyme 2 (ACE2) signaling pathways [ 36 ].…”

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

“… 55 , 62 For chronic heart failure patients, virtual care has enabled effective routine monitoring (eg, heart rhythm, blood pressure, O 2 saturation) associated with better compliance with treatment rates (51% vs 35%) and follow-up rates than in-person care during COVID-19. 63 Among patients with chronic respiratory conditions such as asthma or COPD, remote care has been effective for self-management education (eg, inhaler device training, breathing techniques, recognizing symptoms, forming or complying with action plans, etc. ), leading to improved health outcomes.…”