COVID-19: Cardiology service guide

April 2020

Scope

This information provides guidance on the management of cardiology patients by the Torbay and South Devon Foundation Trust (TSDFT) during the COVID-19 pandemic. The information does not replace clinical judgement and is accurate as of the above date but is subject to change without notice.

National guidance

Clinical guide for the management of cardiology patients during the coronavirus pandemic

Conditions with specific guidance

Some heart patients are considered at extremely high risk of severe illness from Coronavirus. Patients are classed as extremely vulnerable (most at risk) if:

  • Had a transplant at any time, including a heart transplant
  • Pregnant and have significant heart disease - defined by experts as any of the following: coronary heart disease, hypertrophic cardiomyopathy, left ventricular hypertrophy caused by high blood pressure, pulmonary arterial hypertension, valvular heart disease, heart failure, significant congenital heart disease

If patients are in one of these groups, they should protect by staying at home, and minimising contact with people they live with, for the next 12 weeks. This is called shielding. If this applies to you, you will be contacted directly by the NHS with further advice. We are sending letters to the high-risk patients with specific advice and emergency contact details.

British Heart Foundation - heart matters - coronavirus and your health

Patients with underlying cardiac conditions are at significant risk of mortality from COVID-19 infection. It is essential that patients with underlying cardiac conditions are managed as effectively as possible in the community during this pandemic to minimise their risks.

American College of Cardiology (ACC) - COVID -19 and Cardiovascular disease

Cardiac Investigations
  • All are currently restricted with only urgent tests continuing when indicated
  • Please defer referral for non-invasive investigations unless urgent
  • Current routine patients awaiting coronary angiogram, coronary angioplasty, device implantation have been written to advising procedure will not take place for sometime and to contact the Consultant Admin team should their symptoms deteriorate
Cardiac Rehabilitation
Currently no service is being offered to our Rehab patients, due to redeployment of staff.

​2WW referrals

Rapid Access Chest Pain Clinic:
  • If considering a diagnosis of angina then usual referral criteria currently apply
  • All patients will initially be assessed by phone consultation
  • Please send an ECG for all referrals
  • Subsequent investigations such as CT and coronary angiograms will be severely curtailed and reserved for those with refractory symptoms
  • Please start all patients on a statin, betablocker and Aspirin
Rapid Access Heart Failure Clinic:
  • Use NTproBNP to help diagnose and risk assess those with new and acute heart failure
  • Please refer those with NTproBNP greater than 2000ng/L for urgent 2WW review by a cardiologist
  • Please send an ECG for all referrals
  • All efforts should be made to manage symptoms or fluid overload at home with increasing doses of loop diuretic and commence treatment with angiotensin-converting enzyme inhibitors adjunct a beta-blocker if appropriate
  • Known heart failure patients with refractory symptoms can be discussed via the Heart Failure Specialist Nurses (HFSN)
  • The Heart Failure Specialist Nurses (HFSN) are still managing their current caseload (predominantly by phone but when needed by a face-2-face visit) and patients have received a letter from the team

​Urgent referrals

  • Patients with unstable and/or life-threatening symptoms can still be referred for hospital treatment/admission as usual
  • Urgent outpatient referrals can still be made in the usual way but please explain the urgency and why the patient needs to be seen or managed despite the COVID-19 restrictions
  • Please send an ECG with the referral
  • By default all appointments will be phone consultation. Please highlight any reason why this should not be the case

​Routine referrals

  • All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given
  • Please ensure that a practice-based system is in place to check daily for returning referrals with A&G
  • Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.
  • By default all appointments will be phone consultation. Please highlight any reason why this should not be the case
  • Please send an ECG with the referral

Urgent advice

For urgent advice only, please contact the Cardiology-Oncall phone, telephone: 07881 502455

​Advice & Guidance

We continue to offer our Advice and Guidance service via SAICO

​Covid 19 High risk patient advice

Specific guidelines by NHSE and other affiliated societies on patients with underlying high-risk cardiac conditions are available online and the references are listed below

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 05-05-2020

 

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