Co-Management of COVID-19 and Heart Failure During the COVID-19 Pandemic: Lessons Learned

Abstract

The COVID pandemic has brought many new challenges worldwide, which has impacted on patients with chronic conditions. There is an increasing evidence base suggesting an interaction between chronic heart failure (HF) and COVID-19, and in turn the prognostic impact of co-existence of the two conditions. Patients with existing HF appear more prone to develop severe complications on contracting COVID-19, but the exact prevalence in patients with mild symptoms of COVID-19 not requiring hospital admission is poorly investigated. In addition, hospitalization rates for acute HF over the pandemic period appear reduced compared to previous periods. Several key issues remain rather unaddressed and, importantly, a specific algorithm focused on diagnostic differentiation between HF and acute respiratory distress syndrome, a severe complication of COVID-19, is still lacking. Furthermore, recent data suggests potential interaction existing between HF treatment and some anti-viral anti-inflammatory drugs prescribed during the infection, raising some doubts about a universal treatment strategy for all patients with COVID-19. With this manuscript, we aim to review the current literature in this field in light of growing understanding of COVID-19 in the setting of the HF population, its associated morbidity and mortality burden, and the impact on healthcare systems. We hope that this may stimulate a discussion to guarantee a better, more tailored delivery of care for patients with HF in the setting of concomitant COVID-19 infection.

Keywords: SARS-CoV-2; diagnosis; heart failure; management; outbreak.

Fig. 1.

Potential Mechanisms leading to Cardiovascular complication induced by infection, systemic inflammatory and endothelial dysfunction may impair stable HF condition or promote a new HF onset.

Fig. 2.

A specific diagnostic algorithm addressed to the early recognition of acute dyspnea due to respiratory or cardiac manifestations.

Fig. 3.

A stepwise approach may be applied in patients with suspected HF or ARDS starting from clinical examination and blood test up to a more detailed diagnostic screening based on initial screening.