COVID-19 and Acute Heart Failure: Screening the Critically Ill - A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)

Sean Lal; Christopher S Hayward; Carmine De Pasquale; David Kaye; George Javorsky; Peter Bergin; John J Atherton; Marcus K Ilton; Robert G Weintraub; Priya Nair; Mate Rudas; Lawrence Dembo; Robert N Doughty; Gayathri Kumarasinghe; Craig Juergens; Paul G Bannon; Nicole K Bart; Clara K Chow; Jo-Dee Lattimore; Leonard Kritharides; Richard Totaro; Peter S Macdonald

doi:10.1016/j.hlc.2020.04.005

COVID-19 and Acute Heart Failure: Screening the Critically Ill - A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)

Heart Lung Circ. 2020 Jul;29(7):e94-e98. doi: 10.1016/j.hlc.2020.04.005. Epub 2020 May 1.

Authors

Sean Lal¹, Christopher S Hayward², Carmine De Pasquale³, David Kaye⁴, George Javorsky⁵, Peter Bergin⁴, John J Atherton⁶, Marcus K Ilton⁷, Robert G Weintraub⁸, Priya Nair⁹, Mate Rudas¹⁰, Lawrence Dembo¹¹, Robert N Doughty¹², Gayathri Kumarasinghe¹³, Craig Juergens¹³, Paul G Bannon¹⁰, Nicole K Bart⁹, Clara K Chow¹⁴, Jo-Dee Lattimore¹⁰, Leonard Kritharides¹⁵, Richard Totaro¹⁰, Peter S Macdonald¹⁶

Affiliations

¹ Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].
² St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia. Electronic address: [email protected].
³ Flinders Medical Centre and Flinders University, Adelaide, SA, Australia.
⁴ Alfred Hospital and the Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.
⁵ The Prince Charles Hospital, Brisbane, Qld, Australia; The University of Queensland, Brisbane, Qld, Australia.
⁶ The University of Queensland, Brisbane, Qld, Australia; Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
⁷ Royal Darwin Hospital, Darwin, NT, Australia.
⁸ Royal Children's Hospital and the University of Melbourne, Melbourne, Vic, Australia.
⁹ St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
¹⁰ Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
¹¹ Fiona Stanley Hospital, Perth, WA, Australia.
¹² Auckland District Health Board and University of Auckland, Auckland, New Zealand.
¹³ The University of New South Wales, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia.
¹⁴ The University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia.
¹⁵ The University of Sydney, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia.
¹⁶ St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia. Electronic address: [email protected].

Abstract

Up to one-third of COVID-19 patients admitted to intensive care develop an acute cardiomyopathy, which may represent myocarditis or stress cardiomyopathy. Further, while mortality in older patients with COVID-19 appears related to multi-organ failure complicating acute respiratory distress syndrome (ARDS), the cause of death in younger patients may be related to acute heart failure. Cardiac involvement needs to be considered early on in critically ill COVID-19 patients, and even after the acute respiratory phase is passing. This Statement presents a screening algorithm to better identify COVID-19 patients at risk for severe heart failure and circulatory collapse, while balancing the need to protect health care workers and preserve personal protective equipment (PPE). The significance of serum troponin levels and the role of telemetry and targeted transthoracic echocardiography (TTE) in patient investigation and management are addressed, as are fundamental considerations in the management of acute heart failure in COVID-19 patients.

Keywords: Acute cardiomyopathy; COVID-19; High sensitivity troponin; Myocarditis; Screening algorithm; Targeted transthoracic echocardiogram.

Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Publication types

Letter

MeSH terms

Australia / epidemiology
Betacoronavirus
COVID-19
Cardiology* / methods
Cardiology* / organization & administration
Cardiology* / trends
Consensus
Coronavirus Infections* / epidemiology
Coronavirus Infections* / prevention & control
Critical Illness / therapy
Heart Failure* / diagnosis
Heart Failure* / etiology
Heart Failure* / therapy
Humans
Infection Control* / methods
Infection Control* / organization & administration
Myocarditis* / complications
Myocarditis* / virology
New Zealand / epidemiology
Pandemics* / prevention & control
Patient Care Management / methods*
Pneumonia, Viral* / epidemiology
Pneumonia, Viral* / prevention & control
Risk Adjustment / methods
SARS-CoV-2
Societies, Medical