WEBINAR | CVD & COVID-19

The COVID-19 pandemic has created an unprecedented global impact on public health and health care delivery. Outside of direct health consequences, social distancing restrictions have also disrupted the delivery of routine health care across the country.

Social distancing and strict hygiene measures are particularly important for people living with cardiovascular disease (CVD) given their increased vulnerability to the most severe complications of COVID-19. However, there is growing concern that people with chronic diseases are avoiding their regular medical visits, investigations or vaccinations in a bid to avoid contracting COVID-19. 

What’s in the CVD & COVID-19 webinar? 

This is an ‘ask the expert’ style webinar for health care professionals. Hosted by the Heart Foundation along with the Royal Australian College of General Practitioners (RACGP), Australian Primary Health Care Nurses Association (APNA) and NPS MedicineWise.

Duration: 1 hour
Year recorded: 2020

Topics covered:

• The link between COVID-19 and CVD, including the cardiac manifestations of the infection 
• Key takeaways from recent guidance produced by the Cardiac Society of Australia & New Zealand relating to the management of CVD during the COVID-19 pandemic 
• Strategies to stay connected with cardiac patients in the community and support maintenance of their treatment and medication plans 
• Advice on how to leverage recent MBS and medicine related policy changes to support the management of CVD in primary care

Webinar panellists 

The webinar was chaired by Heart Foundation's Natalie Raffoul and the panel consists of: 

A/Prof Sarah Zaman

Associate Professor Sarah Zaman is an Academic Interventional Cardiologist at Monash University and MonashHeart. She is a leader in her field, a National Heart Foundation Future Leader Fellowship and Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship recipient. She is currently leading several areas of cardiovascular research including in the areas of women’s heart health, PCI for ST-elevation myocardial infarction and sudden cardiac death. She holds several appointments including Cardiac Society of Australia/New Zealand Women in Cardiology Group Chair and is the lead author for the latest Australian/New Zealand consensus statement on COVID-19 and CVD.

Prof Mark Morgan

Mark is Professor of general practice at Bond University and a GP with over 20 years’ experience working in rural, regional and urban general practice, currently working in the Gold Coast. He is the Chair of the RACGP Expert Committee for Quality Care, where he advises on healthcare policy and the development of guidelines. He is also the chair of the Primary and Chronic Care Panel for the National COVID-19 Clinical Evidence Taskforce. Mark’s other appointments include chairing the national Practice Incentive Program Quality Improvement (PIP QI) Data Governance Committee. He is a member of the National Preventative Health Strategy, Health Care Homes Implementation Advisory Group and the Australian Strategic and Technical Advisory Group on Antimicrobial Resistance (ASTAG).

Ms Barbara Peterson

Barbara has 12 years’ experience working in primary care as a Practice Nurse, Practice Nurse coordinator and Nurse Immuniser. She has expertise in engaging with practice teams to set up and implement chronic disease management care planning and preventative health assessments. Drawing on her vast primary care experience, she is adapting to the current challenges of triage, screening and testing high risk COVID-19 patients at her practice in Fitzroy. She plays an integral role in supporting the practice team including her principal GP and Practice Manager as they navigate the rapidly evolving COVID-19 related telehealth and face to face appointment strategies.

Dr Anna Samecki

Anna is a General Practitioner based in Sydney with an interest in medical education and health literacy. She currently works as a Medical Adviser for NPS MedicineWise and has been working closely with the team to bring timely updates on COVID-19 to health professionals and consumers. She will be co-hosting a new NPS MedicineWise podcast, called ‘News in minutes’, which will aim to summarise emerging research around COVID-19 treatments and other topical issues. Anna is also a Clinical Editor for HealthPathways Sydney, a CPD Medical Educator for Central and Eastern Sydney Primary Health Network (CESPHN) and is a lecturer and group tutor at The University of Notre Dame (School of Medicine).

Commonly asked questions about CVD &
COVID-19

Our expert panelists have answered the top three most commonly asked questions submitted by registrants before or during the webinar.  

What are the cardiac effects of COVID-19? 

COVID-19 is not just a respiratory infection. Severe COVID-19 infection has been associated with myocardial damage and cardiac arrhythmias. COVID-19 appears to have similar cardiac manifestations as preceding coronavirus outbreaks, such as Severe Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).  

Acute cardiac injury in COVID-19 usually manifests as left ventricular dysfunction, heart failure, ventricular arrythmias, ECG changes and elevated B-type natriuretic  peptide (BNP) and troponin.  

Acute myocardial injury associated with COVID-19 may also manifest as ST elevation in the absence of obstructive coronary artery disease, possibly due to microvascular injury or myocarditis.  

In addition, an increased rate of thromboembolic events has been observed in the context of COVID-19 infection, including pulmonary emboli and deep vein thrombosis with associated raised D-Dimer assays. The National COVID-19 Clinical Evidence Taskforce recommends use of prophylactic anticoagulation in adults with moderate or severe COVID-19 unless contraindicated.  

What is the link between blood pressure lowering medicines and
COVID-19?  

The safety and value of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has been the subject of debate during the COVID-19 pandemic.  

There was early speculation that taking ACE and ARB medications could potentially increase the risk of COVID-19 infection. This was based on the fact that the SARS-CoV-2 virus enters cells by binding to human angiotensin-converting enzyme 2 (ACE2) receptors. 

However, there is currently no clinical data showing greater COVID-19 disease severity or susceptibility in patients taking ACE inhibitors/ARBs. Given the well-established benefits of these medicines in patients with heart failure, hypertension and cardiovascular disease, they should not be ceased.  

Leading national bodies, including the Heart Foundation, Cardiac Society of Australia and New Zealand and the National COVID-19 Clinical Evidence Taskforce recommend continuation of usual care in patients with an indication for ACE inhibitors or ARBs.   

How can we stay connected with our patients during COVID-19?  

There is growing concern that people with chronic diseases, including cardiovascular disease, are avoiding their routine visits and check-ups to avoid potential exposure to COVID-19. Medicare Benefits Schedule (MBS) data shows a significant drop in chronic disease management and health assessment consultations in general practice.  

Telehealth can be used to reach vulnerable patients and continue chronic disease management support. Patients should be reassured that face to face visits are safe and may be necessary. It is important for patients to understand that missing out on potential opportunities to identify small but significant issues now can mean they are faced with greater health consequences down the track. 

Find ways to opportunistically integrate CVD care into routine consultations and consider actively recalling eligible patients for their routine visits.  Offer chronic disease and preventative health consults, especially to your most at-risk cardiac patients.