Cardiac care in the era of COVID-19

As Cedars-Sinai expands telehealth and video visits and resumes surgeries, Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at the Smidt Heart Institute, has her focus on one thing: ensuring that patients with heart disease understand it is safe to be seen, and treated, by Cedars-Sinai healthcare teams.

In three recent publications, Chikwe describes how flattening the COVID-19 curve has come at a "terrible cost" for patients with heart conditions. Chikwe also outlines how surgeons, hospitals and ambulatory care centers can safely resume caring for cardiac surgery patients in the era of the virus.

"Patients are now scared to go to their primary care doctors, their cardiologists' offices and the emergency room, where admissions are down by over 70% in many institutions," reads an article Chikwe co-authored with Christine Albert, MD, MPH, chair of the Department of Cardiology. The article was published in Cardiology, a publication of the American College of Cardiology. "There is no way of knowing how many patients are dying at home of cardiac causes unrelated to COVID-19 because they have delayed seeking medical attention."

The finding that cardiac admissions are down by over 70% in many institutions comes from a published paper in the journal Circulation, of which Chikwe served as an author.

In the study, researchers surveyed 60 cardiac surgery centers in North and South America, Europe, Asia and Australia during the peak of the COVID-19 pandemic. The survey represented over 600 cardiac surgeons and found the median reduction in cardiac surgery case volume was 50% to 75%, with many centers indicating their surgeons were not performing any elective surgeries.

As a follow-up to the study, Chikwe served as lead author on new recommendations published in the Annals of Thoracic Surgery that provide guidance around safely resuming cardiac surgery, research and education amid COVID-19.

The recommendations were developed by committee discussion within a cardiovascular research consortium representing 19 countries and a broad spectrum of cardiac surgery experience. The authors recommended that cardiac surgery be among the first clinical services supported so that elective inpatient and outpatient care can be resumed as soon as possible. Additionally, all patients should be screened for COVID-19 prior to surgery.

Our practical recommendations are intended to support local decision-making according to governmental requirements, regional disease prevalence, institutional capacity and ethics."

Joanna Chikwe, MD, Chair of the Department of Cardiac Surgery, Smidt Heart Institute

Cedars-Sinai staff has already implemented the key recommendations in the consensus statements, including testing before every procedure.

"State-of-the-art screening and prevention services at Cedars-Sinai create a safe environment for the highest quality cardiac care," said Eduardo Marbán, MD, PhD, executive director if the Smidt Heart Institute. "We are committed to ensuring that patients in need not delay seeking treatment for fear of contracting COVID-19."

Before and after procedures, as much as possible is now being done remotely, to save patients the risk and expense of in-person visits.

"Above all, we want all patients – especially those with cardiac care needs – to know it's safe and easier than ever to see your doctor and get the treatment you need," said Chikwe.