Mount Sinai Cardiologist Leads Effort to Outline Guidance for Management of Heart Failure Patients During COVID-19 Pandemic
New scientific statement aims to establish more streamlined care to improve outcomes in this high-risk group
A new scientific statement outlining unique considerations and suggestions for managing heart failure patients during the COVID-19 pandemic was issued today by the Heart Failure Society of America, and Anuradha Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, led the effort to advance this work. The document, published in the September 1 issue of Journal of Cardiac Failure, provides physicians with guidance on how to prevent heart failure and heart transplant patients from getting COVID-19 given their need for frequent monitoring; how to care for them if they get the virus; and the importance of vaccinations for both immunocompromised patients and those taking immunosuppressants.
This first-of-its-kind work is important to streamline care and protect this high-risk patient population. A previous Mount Sinai study conducted by Dr. Lala showed that heart failure patients hospitalized with COVID-19 are nearly twice as likely to die and at triple the risk of intubation when compared to those without the pre-existing heart disease.
“This document is the first of its kind to outline the issues unique to the nexus of heart failure and COVID-19. We believe this comprehensive document will be useful for internists and specialists alike, as well as patients and caregivers. Unfortunately, hospitals continue to face a surge of patients with COVID-19, including patients with heart failure, and/or history of mechanical circulatory support and heart transplant,” says Dr. Lala, the senior author. “Though much progress has been made in terms of our understanding of pathophysiology, development of vaccines, and processes of care, much work remains in understanding how the virus specifically exerts effects on the cardiovascular system and which treatments improve outcomes. Perhaps most importantly, this document underscores the need for our patients to be vaccinated and in some cases receive a booster vaccine.”
Dr. Lala and a team of international heart failure cardiologists, cardiothoracic surgeons, infectious disease physicians, pharmacists, and nurses developed this document based on accumulated data, peer-reviewed studies, and personal experience treating heart failure patients and heart transplant recipients throughout the COVID-19 pandemic. Their scientific statement outlines COVID-19’s impact on the heart and implications for clinical care. Several key points are highlighted:
- Telehealth for treatment and technology developed for remote monitoring of heart failure can help limit the risk of COVID-19 exposure for non-hospitalized patients, and physicians are increasingly relying on these tools.
- The authors provide a suggested algorithm for SARS-CoV2 testing of pre-transplant recipients and donors. For patients waiting for a heart transplant, COVID-19 testing should take place before transplant surgery, in addition to testing of the donor. Transplantation should be postponed if there’s a positive test, even if the patient does not have symptoms. This underscores the importance of mask wearing and social distancing and vaccination for patients on the transplant waiting list.
- Ideally and when feasible, health care workers caring for COVID-19 patients should avoid caring for hospitalized heart failure patients who are not COVID-19 positive.
- Heart failure patients and heart transplant recipients should be vaccinated, and patients who are immunosuppressed, including solid organ transplant recipients, should receive a third dose of mRNA COVID-19 vaccine, according to the Centers for Disease Control and Prevention (CDC)
- Despite initial fear that cardiac medications could lead to high risk of COVID-19, evidence has not supported this. Cardiac medications that are life-saving in the case of heart failure with reduced ejection fraction should be continued.
- Patients with heart failure should be considered eligible for all immunomodulating therapies (including monoclonal antibodies and steroids) used to treat COVID-19 patients, similar to populations without heart failure. Patients with heart failure may have more fluid overload when on these therapies so it’s important for physicians to look for and assess this, and then provide guidance on increasing diuretic medication.
- Vaccination rates remain lower than ideal for this vulnerable population. Designated efforts should be made to educate and inform patients of risks if they contract COVID-19 and to encourage vaccination as much as possible.
“This scientific statement rests on data accumulated to date but are subject to change as the field and research advances. Nonetheless, it is an important first step outlining unique considerations for this high risk population amidst this ongoing, virulent pandemic,” adds Dr. Lala.
Dr. Lala co-chaired the development of this scientific statement with Ankeet Bhatt, MD, a Clinical Research Fellow with the Division of Cardiovascular Medicine at Brigham and Women’s Hospital.
About the Mount Sinai Health System
Mount Sinai Health System is one of the nation’s leading integrated academic health systems and one of the largest in the New York metropolitan area. Its comprehensive system includes seven hospitals, more than 400 outpatient practices, over 600 research and clinical laboratories, the Icahn School of Medicine at Mount Sinai, the Graduate School of Biomedical Sciences, and the Mount Sinai Phillips School of Nursing. Together, the Health System comprises approximately 48,000 employees, more than 9,000 physicians, and 8,600 nurses.
As a leading learning health system, Mount Sinai combines clinical expertise with scientific discovery to improve patient care while training the next generation of health care and biomedical leaders. The Health System provides care across every stage of life, from prenatal care through geriatrics, while advancing personalized medicine through artificial intelligence, data science, and biomedical research.
Mount Sinai is consistently recognized among the nation’s leading academic health systems for patient care, research, and education. The Mount Sinai Hospital is ranked No. 1 in New York by Newsweek and No. 5 on the magazine’s World’s Best Hospitals list. The Icahn School of Medicine at Mount Sinai ranks No. 11 among U.S. medical schools and No. 1 among freestanding medical schools for National Institutes of Health funding, reflecting the strength of its scientific enterprise and leadership in biomedical research.
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