Indiana-ACC Virtual Forum: Inpatient CV COVID-19 Blueprint Julie Clary, MD, MBA, FACC Krannert Institute of Cardiology Indiana University School of Medicine Indiana University Health Physicians Indianapolis Vijay Rao, MD, PhD, FACC Indiana Heart Physicians Franciscan Health Indianapolis Roy Robertson, MD, FACC Parkview Heart Institute Fort Wayne
Discussion Topics • Workforce Utilization • Workforce: Special Considerations • Challenges with CV Imaging • Treatment Considerations
Workforce Utilization • “Dirty” vs. “Clean” teams • Conducting Visits for CV consultants • Modified traditional consults (“no touch”, utilizing hospitalist exam) • Telehealth • eConsults
• Minimizing/balancing provider exposure to the hospital • Surge capacity issues if cardiologists are redeployed • COVID-19 Operational Considerations (Dr. Ed Fry) • https://www.acc.org/latest-in-cardiology/articles/2020/03/20/10/42/covid-19coronavirus-operational-considerations
Inpatient Note Documentation
Workforce: Special Considerations • High Risk Groups • Age (+/- comorbidities) • Immunocompromised • Pregnant
• Group capacity • Without physicians in high-risk groups • For physicians who become ill/quarantined
• Clinician and Staff Wellness
Challenges with CV Imaging • Transthoracic and TEEs • ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak • http://www.onlinejacc.org/content/early/2020/04/06/j.jacc.2020.04.002?_ga =2.123551564.659335144.1586273246-254827300.1574107781
• Cardiac CT • ACC Endorses Clinical Guidance on Cardiovascular CT • https://www.acc.org/latest-in-cardiology/articles/2020/03/27/17/42/acc-endorsesclinical-guidance-on-cardiovascular-ct-covid-19
• Cardiac MR
Treatment Considerations • RAAS Antagonists in COVID-19 • Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment for COVID-19 • Troponin and BNP Use in COVID-19 • Initiating and titrating GDMT considerations
RAAS Antagonists in COVID-19 • HFSA/ACC/AHA Statement Addresses Concerns Regarding Using RAAS Antagonists in COVID-19 • "The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC.
• https://www.acc.org/latest-incardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statementaddresses-concerns-re-using-raas-antagonists-in-covid-19
Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19 • Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19 • https://www.acc.org/latest-incardiology/articles/2020/03/27/14 /00/ventricular-arrhythmia-riskdue-to-hydroxychloroquineazithromycin-treatment-for-covid19
Troponin and BNP Use in COVID-19 • “Given the frequency and non-specific nature of abnormal troponin results among patients with COVID-19 infection, clinicians are advised to only measure troponin if the diagnosis of acute MI is being considered on clinical grounds and an abnormal troponin should not be considered evidence for an acute MI without corroborating evidence.” - James L. Januzzi Jr., MD, FACC. • https://www.acc.org/latest-incardiology/articles/2020/03/18/15/25/troponin-and-bnp-use-incovid19
Additional References • Critical Care for the Non-Critical Care Specialist (Online course from the Society of Critical Care Medicine) • https://covid19.sccm.org/
• COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel • https://academic.oup.com/ehjcimaging/advancearticle/doi/10.1093/ehjci/jeaa072/5815408
• https://ww.inacc.org • https://www.acc.org/covid19