COVID-19 High Risk: What cardiovascular patients need to know about the virus

We know there are some pre-existing conditions that make a diagnosis of COVID-19 even more dangerous. Devin Mehta, M.D., NCH Medical Group Advanced Heart Failure Cardiologist and Director of Heart Failure at NCH, took some time to talk about one of these conditions.

Q: “Heart patient” is a general term used to refer to someone who has a pacemaker or someone with a transplant. Can you tell us what that means?

Dr. Mehta: Correct, a heart patient is a broad term for a patient with cardiovascular disease. Cardiovascular disease includes patients with hypertension, coronary artery disease, prior heart attack or stroke, heart valve problems, heart rhythm abnormalities or heart failure. Patients with heart transplants are often on immunosuppressive medications and are at highest risk given the limited reserve of the immune system to fight viral diseases.

It is important for us to discuss a misnomer of COVID-19. It is a disease that affects patients of all ages; COVID-19 is not just a disease of the elderly. Although the majority of younger patients will have more mild symptoms, they are at risk for transmitting to older patients who may go on to develop more severe symptoms. COVID-19 also spreads through asymptomatic transmission, and patients who don’t know they have the disease can spread it to others through close contact. Despite the fact that younger patients with COVID-19 have a milder disease course, there are examples of younger patients on ventilators and dying around the world, so it is important for everyone to work together and practice stay-at-home instructions.

Q: Why does a heart patient, specifically, need to be concerned about COVID-19?

Dr. Mehta: Patients with cardiovascular disease are more likely to contract the SARS-CoV-2 virus, which causes Coronavirus Disease 2019, more commonly known as COVID-19. They suffer hospitalization, develop more severe illness from the virus, and are more likely to die from COVID-19. The stakes are high for our heart patients, and that is why following the recommendations to avoid getting the virus is extremely important.

Q: Are there any additional precautions or suggestions you have for heart patients, aside from handwashing and social distancing?

Dr. Mehta: Older adults and those patients with underlying cardiovascular disease are at higher risk for developing more serious complications from COVID-19. In addition to these Centers for Disease Control and Prevention (CDC) recommendations—staying at home if possible, washing hands often, keeping at least six feet distance from others, staying up-to-date with vaccinations, and finding ways to cope with stress and anxiety—here are some additional recommendations I have:

• Patients should ask their cardiologists about telemedicine/virtual visits during these challenging times. NCH Medical Group has converted the majority of our routine visits to telemedicine. Most of my patients seem to like this option so they can stay at home.
• When visits with physicians are converted from face-to-face to telemedicine, patients need to be more vigilant about monitoring themselves for new symptoms that could be related to cardiovascular disease and letting their family and cardiologist know about these symptoms. Those patients who cannot express themselves should be watched more closely by family members. As families follow guidelines for staying at home, it may result in extended family or friends being less available to visit with parents, grandparents, etc. We are emphasizing to our cardiovascular patients that they should not ignore chest pain, shortness of breath and acute weight gain. They need to call for help. Our hospital and offices are still open for urgent visits for patients with non-COVID related illness. We are taking all precautions to minimize exposure to patients in our offices and hospital, so patients’ first priority should be their health, rather than fear exposure to COVID-19 if they are developing new or concerning symptoms.
• There are several ways to make a telehealth visit as productive as possible. Patients with a blood pressure cuff at home can prepare for a telemedicine visit by taking their blood pressure prior to their appointment. Patients with a scale should take their weight. Patients should have their medications handy during the call with the physician and review their medications to ensure they are taking the correctly prescribed amounts. They should put the phone on speaker so any family members in the home can also listen to the visit. And lastly, they should have a pen and paper handy to take notes and write down any changes in the care plan recommended by their physician.
• Patients need to focus on their overall health and keep up a healthy diet, exercise, getting enough sleep and managing stress. Continue to take all prescribed medications. At present, the American College of Cardiology and the Heart Failure Society of America recommend patients continue taking ACE inhibitor and ARB (angiotensin receptor blocker) blood pressure medications. The drugs act on the same receptor as this particular coronavirus but the current data does not suggest benefit or harm in patients taking these particular blood pressure medicines. Prior to stopping any heart medications, patients should first discuss whether it is safe to do so with their cardiologist.
• At present, there is no cure for the coronavirus. Patients should be wary of taking medical advice from text threads, social media, news outlets and anecdotal stories—many of these stories can be scary to read, and they don’t always have accurate information. The best way to stay informed about COVID-19 is through the CDC and Illinois Department of Public Health guidelines.
• Extended family members can help by staying in touch and calling their older family members for a check-in, asking about inventory of supplies and groceries and by generally keeping them company.
• All patients should know their doctors are here to help and are available to answer questions. Don’t assume we’re too busy for you right now.

Q: If a heart patient thinks he or she has been exposed to COVID-19, should they call their cardiologist or primary care physician?

Dr. Mehta: We have set up a NCH COVID-19 Hotline for related questions at 847-618-1000, Option 9. In addition to the hotline, our patients with COVID-19 symptoms should call their primary care physician’s office and obtain a referral to the ambulatory COVID clinic. The COVID clinic has capability for lab work, chest X-ray and provider visits to triage patients for home quarantine or direct hospital admission, thereby minimizing exposures in the emergency room. For cardiac-related issues or questions, patients are encouraged to continue to follow usual protocol and contact their cardiologist’s office.