Author + information
- Received March 17, 2020
- Accepted March 17, 2020
- Published online May 4, 2020.
- Elissa Driggin, MDa,∗,
- Mahesh V. Madhavan, MDa,b,∗,
- Behnood Bikdeli, MD, MSa,b,c,
- Taylor Chuich, PharmDa,
- Justin Laracy, MDa,
- Giuseppe Biondi-Zoccai, MD, MStatd,e,
- Tyler S. Brown, MDf,
- Caroline Der Nigoghossian, PharmDa,
- David A. Zidar, MD, PhDg,
- Jennifer Haythe, MDa,
- Daniel Brodie, MDa,
- Joshua A. Beckman, MDh,
- Ajay J. Kirtane, MD, SMa,b,
- Gregg W. Stone, MDb,i,
- Harlan M. Krumholz, MD SMc,j,k and
- Sahil A. Parikh, MDa,b,∗ (, )@sahilparikhmd
- aNew York–Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- bClinical Trials Center, Cardiovascular Research Foundation, New York, New York
- cCenter for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- dDepartment of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- eMediterranea Cardiocentro, Napoli, Italy
- fMassachusetts General Hospital, Boston, Massachusetts
- gCase Western Reserve School of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- hVanderbilt University Medical Center, Nashville, Tennessee
- iIcahn School of Medicine at Mount Sinai, New York, New York
- jSection of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- kDepartment of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Sahil A. Parikh, Columbia University Irving Medical Center, New York–Presbyterian Hospital, 161 Fort Washington Avenue, 6th Floor, New York, New York 10032.
• Patients with pre-existing CVD appear to have worse outcomes with COVID-19.
• CV complications include biomarker elevations, myocarditis, heart failure, and venous thromboembolism, which may be exacerbated by delays in care.
• Therapies under investigation for COVID-19 may have significant drug-drug interactions with CV medications.
• Health care workers and health systems should take measures to ensure safety while providing high-quality care for COVID-19 patients.
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission. We hereby review the peer-reviewed and pre-print reports pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
↵∗ Drs. Driggin and Madhavan contributed equally to this work.
Dr. Madhavan has received support from an institutional grant by the National Institutes of Health/National Heart, Lung, and Blood Institute to Columbia University Irving Medical Center (T32 HL007854). Dr. Bikdeli has served as a consulting expert, on behalf of the plaintiff, for litigation related to a specific type of inferior vena cava filters. Dr. Brodie has received research support from ALung Technologies; and has served on the Medical Advisory Boards of ALung Technologies, Baxter, BREETHE, Xenios, and Hemovent. Dr. Kirtane has received support from institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, Philips, and ReCor Medical. Dr. Stone has received speaking or other honoraria from Cook, Terumo, Qool Therapeutics, and Orchestra Biomed; has served as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, and Matrizyme; and has received equity/options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, and Valfix. Dr. Krumholz has worked under contract with the Centers for Medicare and Medicaid Services to support quality measurement programs; has received a research grant, through Yale, from Medtronic and the U.S. Food and Drug Administration to develop methods for post-market surveillance of medical devices; has received research grants from Medtronic; and has received a research grant from Johnson & Johnson, through Yale University, to support clinical trial data sharing; has received a research agreement, through Yale University, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion; has collaborated with the National Center for Cardiovascular Diseases in Beijing; has received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation; has received payment from the Ben C. Martin Law Firm for work related to the Cook CELECT inferior vena cava filter litigation; has received payment from the Siegfried and Jensen Law Firm for work related to Vioxx litigation; has chaired the Cardiac Scientific Advisory Board for UnitedHealth; was a participant/participant representative of the IBM Watson Health Life Sciences Board; has served on the Advisory Boards of Element Science and Facebook; has served on the Physician Advisory Board for Aetna; and cofounded HugoHealth, a personal health information platform, and Refactor Health, an enterprise health care artificial intelligence–augmented data enterprise. Dr. Parikh has received institutional grants/research support from Abbott Vascular, Shockwave Medical, TriReme Medical, Sumodics, Silk Road Medical, and the National Institutes of Health; has received consulting fees from Terumo and Abiomed; and has served on the Advisory Boards of Abbott, Medtronic, Boston Scientific, CSI, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 17, 2020.
- Accepted March 17, 2020.
- 2020 American College of Cardiology Foundation
- Central Illustration
- Methodologic Considerations
- Pathophysiology, Epidemiology, and Clinical Features of COVID-19
- Prevalence of CVD in Patients With COVID-19
- Cardiovascular Sequelae Associated With COVID-19
- Drug Therapy and COVID-19: Interactions and Cardiovascular Implications
- Considerations for Health Care Workers
- Considerations for Health Systems and Management of Noninfected CV Patients
- Conclusions and Future Directions