ESC Guidance on CVD Diagnosis, Management Amid COVID-19

Megan Brooks

April 26, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

The European Society of Cardiology (ESC) has issued guidance on the diagnosis and management of cardiovascular disease during the COVID-19 pandemic.

"Patients with cardiovascular risk factors and established cardiovascular disease represent a vulnerable population when suffering from COVID-19, and patients with cardiac injury in the context of COVID-19 have an increased risk of morbidity and mortality," Stephan Windecker, MD, PhD, Swiss Cardiovascular Center, Bern, Switzerland, told Medscape Medical News.

Therefore, the ESC assembled a group of experts and clinicians with experience in the care of patients with COVID-19 to provide guidance on all aspects of CV care during the COVID-19 pandemic, Windecker explained.

The guidance document, which is posted on the society's website, is organized into chapters summarizing "essential" information in figures, tables, and treatment pathways and provides key bullet points up front.

It provides information on epidemiology, pathophysiology, strategies to diagnose SARS-CoV-2, protective measures for healthcare personnel and patients, triage systems, and diagnosis of cardiovascular conditions in COVID-19 patients.

A "Living" Document Subject to Change

The management section discusses treatment pathways in patients with acute and chronic coronary syndromes, heart failure, valvular heart disease, hypertension, pulmonary embolism, and arrhythmias.

"Noteworthy," Windecker said, "arrhythmogenic considerations of COVID-19 therapeutic agents are discussed as well as the use of oral anticoagulants. The document closes with a section providing useful information for patients with CV disease."

The document notes that there is currently no evidence-based treatment for COVID-19 infection and experimental treatment may have cardiac side effects. It advises that experimental treatments be part of controlled trials whenever possible.

Windecker emphasized that this document is not a guideline, but rather a guidance document and does not replace any of the existing ESC guidelines. Nor should its content interfere with recommendations provided by local and national healthcare authorities.

"The document is comprehensive in scope, but provides only a snapshot with preliminary findings that may change and mature over time with increasing knowledge," he told Medscape Medical News.

"Therefore, via this living document, we hope to continue to engage with our colleagues on the frontlines and receive contributions, comments, and suggestions, which may be considered for future updates," he said.

Windecker has previously disclosed institutional research grants from Abbott, Amgen, Bayer, Bristol Myers-Squibb, Boston Scientific, Biotronik, CSL Behring, Edwards Lifesciences, Medtronic, Polares, and Sinomed.

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