What Heart Failure Patients Need to know about COVID–19

COVID-19 is a novel coronavirus. It contains genetic material that can infect human cells which will then multiply, producing more virus. The COVID–19 pandemic is a quickly evolving public health emergency. It started in late December 2019, in Wuhan City, Hubei Province, China, and has rapidly spread to countries and territories worldwide.

The spread from human-to-human occurs via coughing and sneezing. Respiratory droplets containing the virus may infect you through contact with the mouth, nose or eyes. The virus can also contaminate surfaces and survive for up to several days or more. At least 80% of infected patients experience mild symptoms and recover without intensive medical intervention.

Signs of COVID-19 include flu-like symptoms such as fever, new and persistent cough, fatigue, headache and sore throat. The virus can lead to pneumonia in some patients, with progressive breathing difficulties and, in more severe cases, can be fatal. However, the overall case fatality rate of COVID-19 based on initial published reports remains low at approximately 2%.

What does COVID–19 mean for patients with heart failure?

Serious complications, with a need for hospitalisation, increase significantly with age. People over 70 years old are at particularly high risk as many also suffer from heart failure and other underlying medical conditions.

Patients with chronic respiratory disease, chronic cardiovascular disease such as heart failure, diabetes, hypertension, cancer, autoimmune diseases or those on immunosuppressant medication following transplantation are more vulnerable to the worst outcomes of the virus. Heart failure patients may have at least one or more of these other conditions and are therefore subject to a higher risk of hospitalisation and serious complications.

For the above reasons, the following recommendations are suggested:

Recommendations for Patients with Heart Failure during the COVID-19 Pandemic

General Prevention Measures

1 - Avoid close contact with other persons even if they are not sick (handshakes, hugs, kisses).

2 - Keep at least 2 meters distance from people who are sick or suspected of being infected (those who have recently traveled from a country with a recent outbreak or been exposed to a COVID-19 patient).

3 - Stay at home and avoid densely populated areas.

4 - Wash your hands frequently with soap and warm water for at least 20 seconds after having been out of your home as well as after using the bathroom. You should also wash your hands after blowing your nose, sneezing and before eating. Try to avoid touching computers, notebooks, smartphones, remote controls and other possibly contaminated surfaces if they have been used by someone else.

5 - Don’t stay in the same room with a suspected sick person.

6 - Avoid gatherings, meetings and crowds, and limit shopping as much as possible.

7 - Avoid using public transport unless essential.

8 - Avoid traveling especially to countries with many cases except for emergencies.

9 - Avoid touching your eyes, nose or mouth. This can be difficult but is important. Consider using gloves to reduce the tendency to touch your face.

10 - Frequently clean surfaces at home or at work with soap and water or alcohol-based sterilizer or spray. Use your own hand towel.

Practical Tips

1 - Try to keep active and exercise at home with available equipment. Patients can also exercise at home without any special equipment. Music is often useful.

2 - Try to secure enough of your heart failure medications for at least 3 months.

3 - Attempt to stay on your current medication treatment and dosages. This includes diuretics and beta-blockers. It is also important that patients continue treatment with ACE inhibitors, ARBs and ARNIs.

4 - In case you are unable to get all your medications from the pharmacy or run out of them, continue taking what is available and contact your doctor or nurse.

5 -Do not self-medicate. If you have symptoms such as increasing shortness of breath, discuss any adjustments in medical treatment with a health care professional. Telephone contact will often be enough to make the decision about adjustments in medication, such as diuretics, or the need for evaluation at hospital.

6 -Try to avoid abruptly stopping drugs that lower heart rate such as beta-blockers. Anti-inflammatory drugs (NSAIDs) should be avoided.

7 - Seek medical attention if you experience any of the following symptoms: chest pain, irregular or fast heart rate; progressive shortness of breath, severe cough, dizziness or fainting, as you may need hospitalization and intensive monitoring.

8 - When the situation in your country allows, try to remain current with vaccinations. These include seasonal influenza vaccine and the pneumococcal vaccine given the increased risk of secondary bacterial infection with COVID-19.

9 -Avoid routine clinic/hospital visits in heart failure clinics or other clinics in areas with active COVID-19 outbreaks. Substitute visits with telephone or telehealth contact if applicable.

10 - If you have been in direct contact with a suspected COVID-19 infected patient, you should isolate yourself, monitor for signs and symptoms of the disease and consider notifying your doctor or nurse.

11 - If quarantine is recommended, protect others by staying home in your room. If you feel like you have a cold or flu, cover your cough or sneeze with a tissue or into your elbow. You should use a mask to prevent spreading virus.

12 - Seek information from your local authority about the coronavirus epidemic in your area.

Recommendations for Patients Who Develop Symptoms

1 - Patients with heart failure are often short of breath on exertion and these patients can also get the common cold or the seasonal flu and have more difficulty breathing. However, if the patient’s symptoms are rapidly progressive and breathing becomes difficult with minimal activity and is accompanied by fever and a dry cough, contact with a doctor or nurse is necessary.

2 - If signs and symptoms appear suggestive of COVID-19 infection, treat yourself with supportive measures as with any cold or flu. Signs of COVID-19 can include flu-like symptoms such as fever, cough, shortness of breath, fatigue, headache and sore throat.

3 - Fluids are important and paracetamol is often effective in reducing symptoms and fever. Anti-inflammatory drugs (NSAIDs) should be avoided.

4 - You should use a mask to prevent spreading of the virus to others.

5 - If you suspect that you have been infected, you should practice self-quarantine and contact your primary care physician, heart failure nurse or heart failure physician for further recommendations regarding the necessity of testing for the COVID-19 virus.

Download the advice in PDF format by clicking here

 

For more information on COVID-19 & heart patients please visit the European Society of Cardiology website.