The British Cardiovascular Intervention Society (BCIS) and the British Cardiovascular Society (BCS) have endorsed guidance published by NHS England and NHS Improvement on the provision of cardiology services during the COVID-19 pandemic.
A joint statement from Nick Curzen, president of BCIS, and Simon Ray, president of BCS, points out: “It is important to bear in mind that while there is no specific treatment for COVID-19, there are life threatening cardiac conditions which cardiologists do know how to treat, and for which we have well organised and effective care pathways.”
The NHS document—Clinical guide for the management of cardiology patients during the coronavirus pandemic—outlines management options and how leadership should be structured in response to the crisis.
It acknowledges: “Elective cardiology services will be severely curtailed by the pandemic and careful planning is required to minimise the impact on patients requiring urgent or emergency care while protecting resources for the response to coronavirus. There is a possibility that the ability to assess and treat urgent or emergency cardiology patients may be compromised by the inability to transfer patients between hospitals, lack of beds, or staff sickness.”
Specific areas addressed in the guidance include bradycardia pacing, implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) implantation, cardiac implantable electronic device (CIED) generator replacement, and ablation, as well as treatment of heart failure.
Elective percutaneous coronary intervention (PCI) should be deferred and non-ST segment myocardial infarction (NSTEMI) assessed on a case-by-case basis. If it is not possible to follow current NSTEMI pathways due to ITU capacity or other issues, then the document recommends that PCI should be used in place of surgery in multivessel disease where feasible. For patients with valve disease, elective interventions should be deferred.
The joint BCIS/BCS statement says that primary PCI “must remain the standard of care for STEMI during the pandemic and strenuous efforts need to be made to made to preserve PPCI services and to make them as efficient and as effective as possible. There are likely to be situations where it will prove impossible to provide timely PPCI and a patient needs to be thrombolysed but this should not be a default response and remain the exception rather than the rule.”
For patients in heart failure or at high risk of admission in heart failure, the NHS guidance suggests they be considered on a case-by-case basis, and that current pathways should be followed where possible; if this is not possible due to a shortage of ITU beds or other constraints, the document advises “transcatheter aortic valve intervention (TAVI) can be considered as an alternative to surgery in aortic stenosis”.
The BCIS and BCS in their statement also reference the “critical importance of having appropriate PPE [personal protective equipment] available for cath lab staff”; the societies say they are “actively lobbying about this on behalf of our members”.