How Vulnerable Are Patients With Cardiovascular Disease to COVID-19, Flu Complications?

Patients with cardiovascular disease (CVD) are especially vulnerable to respiratory infections, although uncertainty remains on just what damage COVID-19, caused by the coronavirus, can do in these patients. The American College of Cardiology (ACC) is steadfast in its reminder that viral respiratory infections can have a greater effect on patients with cardiac issues, especially in light of the flu and coronavirus spreads.

COVID-19

On March 6, ACC President Richard J. Kovacs, MD, FACC, issued a statement about the publication of “ACC Clinical Bulletin: COVID-19 Clinical Guidance for the CV Care Team,” which contains guidance for cardiovascular care teams during the COVID-19 crisis, which overlaps with the current flu season.

The ACC’s clinical bulletin provides these top tips for cardiovascular care teams:

• Strategize for how to identify and isolate patients who have COVID-19 symptoms.
• Advise all patients that they have a higher risk of respiratory infections and of contracting COVID-19, as well as a worse prognosis.
• Administer fluids cautiously.
• Urge patients to take additional, albeit reasonable, precautions that align with CDC recommendations.
• Encourage the use of telehealth in areas with active outbreaks.
• Stay current with vaccinations, especially the pneumococcal vaccine.
• Vaccinate patients against influenza according to ACC/American Heart Association guidelines.

Deserving particular mention is the 10.5% fatality rate among patients with established CVD who come down with COVID-19, as well as the following:

• 16.7% of patients developed arrhythmia and 7.2%, acute cardiac injury.
• There have been cases of acute-onset heart failure, myocardial infarction, myocarditis, and cardiac arrest.
• Cardiac complications from COVID-19 are on par with those from severe acute respiratory syndrome and Middle East respiratory syndrome.

In addition, noting that “COVID-19 is a quickly evolving public health emergency,” the ACC’s guidance document stresses it is meant to be used in addition to guidance from the CDC, health authorities, and physicians’ institutions’ infectious disease protocols.

Influenza

The flu season is also in full swing, with an estimated 440,000 individuals hospitalized so far in the United States alone, according to the CDC, and almost 8.2% of them dying, as of February 22. An article in Cardiology magazine, published on the same day as the ACC COVID-19 guidance, notes, “COVID-19 provides a potent reminder of the seasonal threat that is influenza infection on patients with cardiovascular disease.”

Influenza has been shown to be a risk factor for HF in patients with CVD. Study data from the National Inpatient Sample database show that patients hospitalized for HF who present with the flu, versus those who do not, have increased incidences of acute respiratory failure (36.9% vs 23.1%; odds ratio [OR], 1.95; P <.001) and acute respiratory failure requiring mechanical ventilation (18.2% vs 11.3%; OR, 1.75; P <.001), as well as longer mean hospital stays (5.9 vs 5.2 days; P <.001).

“Young people might think they don’t need to bother with a flu shot because they’re young and healthy, but what happens when you get flu and give it to the elderly person, your grandparents maybe, who aren’t young and healthy and might have heart disease?” posed Mohammad Madjid, MD, FACC, from UTHealth in Houston, Texas. “Also, just practically speaking, if this coronavirus is coming, this is not a good year to risk being hospitalized for flu, if only because it will present a diagnostic challenge to determine whether you have flu or COVID-19.”