Cardiovascular and Heart Failure Management of COVID-19: The New York Experience

Abstract

The COVID-19 pandemic in New York started in March 2022 and rapidly escalated in a devastating way. There were almost 3,000 deaths per million population in United States as of May 5, 2022. In addition to pulmonary manifestations, COVID-19 is associated with deleterious effects on the cardiovascular system by increasing the risks of myocardial infarction, arrhythmias, and heart failure (HF). Apart from the common pathology including direct vascular or myocardial infection, systemic proinflammatory response, sympathetic stimulation, myocarditis, myocyte necrosis, hypercoagulability, and acute respiratory distress syndrome, a recent study had identified microthrombi as the predominant acute cardiac pathology. Cardiac involvement is associated with poorer clinical outcomes. The mortality is particularly high among HF patient and heart transplant recipients. Immunosuppression for most heart transplant recipients during COVID-19 infection was reduced. Extracorporeal membrane oxygenation (ECMO) can be used in patients with HF with predominance of refractory hypoxemia; veno-arterial-venous ECMO strategy has been developed in the setting of mixed severe acute respiratory distress syndrome and circulatory failure. In response to the pandemic crisis and restrictions, the patient care delivery model has been converted to telehealth. NewYork-Presbyterian Hospital in New York transitioned its management of HF program, initiated a shared clinic model, and introduced a comprehensive remote monitoring program to manage patients with HF and heart transplant, and left ventricular assist device.