The onset of the COVID-19 pandemic has been associated with challenges in cardiovascular medicine. Patients with hypertension and heart disorders like heart failure are at a higher risk of more severe COVID-19 symptoms. This position statement draws from expert opinion based on limited data in studies from mostly China and Europe.

• Mortality and morbidity in cardiovascular disease (CVD) patients with COVID-19 — Patients with a pre-existing CVD or CVD risk factors have higher case fatality rates. This may be due to low cardio-respiratory reserves in these patients or the aggravation of the underlying CVD.

• Clinical presentation of heart failure and COVID-19 — Patients with COVID-19 presenting with respiratory symptoms can also have worsening heart failure or acute decompensated heart failure. Fatigue has also been reported. However, cardiac symptoms like chest pain and palpitations lack specificity.

• N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) — If heart failure is suspected, serum NT-proBNP levels or BNP levels should be assessed for prognostic and diagnostic information.

• Managing patients with pre-existing CVDs — Identifying and isolating CVD patients with COVID-19 symptoms are imperative. It is also essential to ensure that patients with heart failure are adequately supplied with and adhere to their medications. Telemedicine tools should be implemented to allow sustained contact between patients and healthcare personnel.

• Managing patients with COVID-19 and heart failure — Careful monitoring of fluid balance, electrolytes, and renal function is essential. NSAIDs like ibuprofen should be avoided; paracetamol should be considered instead as the preferred analgesic. If COVID-19 and cardiovascular medications have to be used concomitantly, the drug interactions should be monitored. Healthcare personnel and caregivers should adequately protect themselves by using personal protective equipment.

• Medical management of heart failure patients — For patients with heart failure with reduced ejection fractions, drugs like beta blockers, angiotensin type II receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI), and angiotensin converting enzyme inhibitors (ACEI) should be continued unless contraindicated.

Research on the association between CVDs and COVID-19 is continuing to evolve, and the long-term impacts of COVID-19 on cardiovascular function is yet to be established. Nevertheless, healthcare personnel should be vigilant about the clinical implications of the COVID-19 infection on CVD patients, and about the development of cardiovascular complications in patients with COVID-19.

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