European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis
The Task Force for the management of COVID-19 of the European Society of Cardiology
(2022) European heart journal, volume 43, issue 11, pp. 1033 - 1058
(Article)
Abstract
Aims:Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the
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diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. Methods and results: A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. Conclusion: This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Keywords: ACE2, Arrhythmias, Biomarkers, Cardiogenic shock, COVID-19, Myocardial injury, Myocarditis, Non-invasive imaging, Cardiology and Cardiovascular Medicine
ISSN: 0195-668X
Publisher: Oxford University Press
Note: Funding Information: reports research grant via his institution from Boston Scientific; speaker fees from Abbott Vascular and Boston Scientific. H.T. is the president-elect of the German Cardiac Society and is chair of the 2020 ESC NSTE-ACS Guideline. B.W. reports lecture fees for symposia on hypertension, unrelated to the content of those manuscripts from Pfizer, Boehringer, Servier, and Daiichi Sankyo; travel/accommodation fees to conference from Pfizer, Boehringer, Servier, and Daiichi Sankyo. B.W. is the chair of the most recent 2018 ESC-ESH Hypertension Guideline. All other authors declared no conflict of interest. Funding Information: Conflict of interest: C.B. reports grants or contracts as follow: Medical Research Council: Population Health Research Unit (Director) 2019–24; Medical Research Council: PHRU capital award 2019–20; Medical Research Council: Therapy Acceleration Laboratory Award 2021; BHF: Project Grant no. PG/18/16/33570 Cholesterol Treatment Trialists’ (CTT) Collaboration: Meta-analyses Funding Information: The following people reviewed the document: Victor Aboyans (France), Stefan D. Anker (Germany), Robert A. Byrne (Ireland), A. John Camm (Italy), Andrew J.S. Coats (Italy), Rudolf A. de Boer (The Netherlands), Stefanie Dimmeler (Germany), Donna Fitzimons (UK), Christoph Gräni (Switzerland), Christian Hamm (Germany), Richard Haynes (UK), Bernard Iung (France), Adnan Kastrati (Germany), Patrizio Lancellotti (Belgium), Julinda Mehilli (Germany), Béla Merkely (Hungary), Lis Neubeck (UK), Katja E. Odening (Switzerland), Raffaele Piccolo (Italy), Lorenz Räber (Switzerland), Tobias Reichlin (Switzerland), Manel Sabate (Spain), P. Christian Schulze (Germany), Iain A. Simpson (UK), Lars Sondergaard (Denmark), Miguel Sousa-Uva (Portugal), Stefan Stortecky (Switzerland), Didier Tchétché (France), and Katja Zeppenfeld (The Netherlands). Support for title page creation and format was provided by AuthorArranger, a tool developed at the National Cancer Institute. Matthieu Depuydt (European Society of Cardiology) coordinated the development of the manuscript. C.B. reports grants or contracts as follow: Medical Research Council: Population Health Research Unit (Director) 2019-24; Medical Research Council: PHRU capital award 2019-20; Medical Research Council: Therapy Acceleration Laboratory Award 2021; BHF: Project Grant no. PG/18/16/33570 Cholesterol Treatment Trialists' (CTT) Collaboration: Meta-analyses of individual participant adverse event data from randomized controlled trials of statin therapy (co-applicant) 2018-20; Boehringer Ingelheim: EMPA-KIDNEY trial (study co-chair) 2018-22; NIHR HTA 17/140/02: Cost-effectiveness of statin therapies evaluated using individual participant data from large randomized clinical trials (co-applicant) 2018-22. C.B. reports unpaid roles as chair of the European Society of Cardiology Clinical Practice Guidelines Committee and as vice-chair of the British Heart Foundation Clinical Studies Committee. S.W. reports research and educational grants via his institution from Abbott, Amgen, Astra Zeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi Aventis, Sinomed, Terumo, and V-Wave. S.W. is an unpaid member of the Pfizer Research Award selection committee in Switzerland and of the Women as One Awards Committee. He is a member of the Clinical Study Group of the Deutsches Zentrum für Herz Kreislauf-Forschung and of the Advisory Board of the Australian Victorian Heart Institute. He is a chairperson of the ESC Congress Program Committee and a former chairperson of the ESC Clinical Practice Guidelines Committee. S.W. serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave, and Xeltis but has not received personal payments by pharmaceutical companies or device manufacturers. He is also member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. E.A. reports honoraria for lectures from Biosense Webster. D.C. reports personal consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, and Daiichi Sankyo. J-P.C. reports grants or contracts from Medtronic, BMS-Pfizer for the ATLANTIS trial; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from BMS-Pfizer, Webmed, AstraZeneca, and Sanofi. T.C. reports consulting fees from Boston Scientific, Medtronic, and Edwards; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Boston Scientific, Medtronic, and Edwards; and participation on a Data Safety Monitoring Board or Advisory Board for CERC. J.R.G.-J. payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Ferrer International, Menarini, MSD, Novartis, Novo Nordisk, Pfizer, Sanofi Aventis, and Servier, outside the submitted work. T.J.G. is the editor-in-chief from the Cardiovascular Research journal. T.J.G. reports speaker fees from Merck and participation to the steering committee of the COMPASS trial from the Public Health Research Institute. H.H. reports unconditional Research Grants for the University of Antwerp and/or University of Hasselt from Bracco Imaging Europe; Daiichi Sankyo, Boehringer Ingelheim, Abbott, Medtronic, Biotronik, St. Jude Medical, and Fibricheck/Qompium. As EHRA president 2018-2020, H.H. reports no personal honorarium for any industry-related speaker or advisory role between March 2017 and September 2020. After September 2020, H.H. reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events. B.I. reports other financial or non-financial interests as leader for a small single-centre phase 2 RCT testing the benefits of i.v. meto-prolol in critically ill COVID19 patients. Funds from his laboratory were used and there was no relationship with any third party. Metoprolol is not approved for ARDS (COVID related or non-COVID related) and thus this trial was an initial step for its repurpos-ing. Metoprolol is out of patent and has no commercial interest. F.A.K. reports research grants via his institution from Bayer, Bristol Myers Squibb, Boehringer Ingelheim, MSD, Daiichi Sankyo, Actelion, the Dutch thrombosis association, The Netherlands Organisation for Health Research and Development, and the Dutch Heart foundation, all outside the current work. F.K. is a member of the Dutch guideline committee on antithrombotic therapy, and the ASH guideline on thromboprophylaxis in COVID-19 patients. F.K. is a member of the nucleus of the ESC Working Group on RV function and pulmonary circulation. S.V.K. reports grants or contracts via his institution from Bayer AG, Boston Scientific, Servier, Actelion-Janssen, and Daiichi Sankyo; consulting fees from Bayer AG, Pfizer-Bristol Myers Squibb, Daiichi Sankyo, and Boston Scientific; payment or honoraria for lectures, presentations from Bayer AG, Pfizer-Bristol Myers Squibb, Daiichi Sankyo Boston Scientific, and MSD Novartis. U.L. reports grants or contracts from Bayer, Novartis, and Amgen; consulting fees from Bayer, Novartis, Amgen, Sanofi, and Pfizer; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Bayer, Novartis, Amgen, Sanofi, and Pfizer. C.L. reports grants or contracts from Biotronik, Medtronic, Boston Scientific, Microport, and Abbott and support for attending meetings and/or travel from Biotronik, Medtronic, Boston Scientific, Microport, and Abbott. M.L. reports honoraria for the role of faculty member of two webinars on COVID-19 from a private society committed to educational initiatives and the Italian Association of Hospital Cardiologists. N.M. reports a research grant from Getinge Global US and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Bristol Myers Squibb. C.M. reports research support payments via his institution from Research support from several diagnostic companies, the Swiss National Science Foundation, and the Swiss Heart Foundation; consulting fees from Idorsia; and payment via his institution for his participation on a Data Safety Monitoring Board or Advisory Board from Roche and from Osler. A.S.P reports consulting and proctoring payment via her institution from Medtronic; consulting and proctoring payment from Boston Scientific; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from Medtronic, Abbott, and Boston Scientific; payment for expert testimony via her institution from Medtronic, Boston Scientific, and Abbott; and participation to the steering committee for the ongoing SMART trial. F.P. reports travel expenses from Abbott Vascular, Edwards Lifesciences, and Polares Medical. P.P. reports direct consulting fees from Boehringer Ingelheim, Pfizer, and Bayer AG; direct honoraria for lectures from Bayer AG, Bristol Myers Squibb, Boehringer Ingelheim, Pfizer, Sanofi, Roche, and Boston Scientific. M.R. reports research grant via his institution from Medtronic, Boston Scientific, Terumo, Biotronik, and GE Healthcare. S.R. reports research grant via his institution from Actelion, AstraZeneca, Bayer, Janssen, and Novartis; remunerations for lectures from Abbott, Acceleron, Actelion, Arena, Bayer, Ferrer, Janssen, MSD, Novartis, Pfizer, United Therapeutics, and Vifor. G.S. reports research grant via his institution from Boston Scientific; speaker fees from Abbott Vascular and Boston Scientific. H.T. is the president-elect of the German Cardiac Society and is chair of the 2020 ESC NSTE-ACS Guideline. B.W. reports lecture fees for symposia on hypertension, unrelated to the content of those manuscripts from Pfizer, Boehringer, Servier, and Daiichi Sankyo; travel/accommodation fees to conference from Pfizer, Boehringer, Servier, and Daiichi Sankyo. B.W. is the chair of the most recent 2018 ESC-ESH Hypertension Guideline. All other authors declared no conflict of interest. Publisher Copyright: © The European Society of Cardiology 2021. All rights reserved.
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