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COVID-19 Level 2

Letter to Patients 

We are all looking forward to COVID Level 2 and a return to a new normality. We have resumed full cardiac services. All our staff have returned to work. Patient and staff safety remain paramount with the ongoing need to social distance which will mean some changes to our routines and may mean we run a little slower to ensure careful cleaning between patients having procedures. At times we may need to ask you to wait in your car to minimise the number of patients in our waiting room and we would be grateful if you would bring a maximum of one support person to your appointments.

Remote consults by telephone or Zoom have been a new experience over the COVID lockdown and we hope to continue with them where appropriate into the future although expect that we will now see most of our patients face to face. Difficult times like the COVID crisis often lead to new innovative developments such as telemedicine which we hope to continue.

We look forward to seeing you in the future. If you wish to schedule an appointment please call us on 09 623 1020.



 

heartfoundation

Heart Foundation - Your COVID-19 questions answered

As New Zealand prepares for the shut-down of all but essential services nationwide and people are asked to stay home, it is more important than ever to look after your heart health, especially if you are already living with a heart condition.

COVID-19 is a new type of coronavirus and we are learning more about who is at most risk every day. At this time, we know that people with chronic heart disease, heart failure and high blood pressure are at much higher risk of severe symptoms and the worst outcomes.

Having a heart condition does not mean you are more likely to catch coronavirus, but you are at higher risk of complications if you do catch it.

Advice for people living with heart disease during the Alert Level 4 isolation period:

  • Follow government guidance on social distancing and good hygiene.
  • Reduce contact with people as much as possible. Try to find someone who can help with your shopping and essential items but avoid physical contact with them.
  • Phone your doctor about getting a flu shot. People with heart disease are considered a priority for flu immunisation. Follow advice from your doctor or health provider about contacting them by phone rather than in person.
  • If you are taking medication, you should make sure you have enough at home.
  • We recommend that you find someone who can collect your medication for you and avoid contact with them when you receive it.

It is important to keep up heart health practices

  • You should continue to eat heart healthy foods
  • Find ways to remain active
  • Look after your mental wellbeing
  • If you do have symptoms of a heart attack call 111 for help immediately.

Useful links

Advice for vulnerable people during this time COVID-19.Govt.NZ

Ministry of Health advice on self-isolation

 

ACC

HFSA/ACC/AHA Statement Addresses

Concerns Re: Using RAAS Antagonists in

COVID-19

Mar 17, 2020

ACC News Story

*The following joint statement from the ACC, American Heart Association and Heart Failure Society of America was posted online on March 17 and addresses using renin angiotensin aldosterone system (RAAS) antagonists in COVID-19. "The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC. "We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research."

Patients with underlying cardiovascular diseases appear to have an increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients also may have severe cardiovascular damage. Angiotensin converting enzyme 2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19. In a few experimental studies with animal models, both angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Though these have not been shown in human studies, or in the setting of COVID-19, such potential upregulation of ACE2 by ACE inhibitors or ARBs has resulted in a speculation of potential increased risk for COVID-19 infection in patients with background treatment of these medications.

ACE2 is a homolog of angiotensin converting enzyme (ACE). ACE2 negatively regulates the renin angiotensin system by converting Angiotensin II to vasodilatory

Angiotensin 1-7, diminishing and opposing the vasoconstrictor effect of

angiotensin II. ACE2, ACE, angiotensin II and other renin angiotensin aldosterone system (RAAS) system interactions are quite complex, and at times, paradoxical. Furthermore, tissue expression of ACE2 differ in heart, kidneys and lungs of healthy patients, cardiovascular disease patients, and coronavirus-infected patients, and its role in the setting of COVID-19 infection in patients with cardiovascular disease is unclear. Furthermore, in experimental studies, both ACE inhibitors and ARBs have been shown to reduce severe lung injury in certain viral pneumonias, and it has been speculated that these agents could be beneficial in COVID-19.

Currently there are no experimental or clinical data demonstrating beneficial or adverse outcomes with background use of ACE inhibitors, ARBs or other RAAS antagonists in COVID-19 or among COVID-19 patients with a history of cardiovascular disease treated with such agents. The HFSA, ACC, and AHA recommend continuation of RAAS antagonists for those patients who are currently prescribed such agents for indications for which these agents are known to be beneficial, such as heart failure, hypertension, or ischemic heart disease. In the event patients with cardiovascular disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient's hemodynamic status and clinical presentation. Therefore, be advised not to add or remove any RAAS-related treatments, beyond actions based on standard clinical practice.

These theoretical concerns and findings of cardiovascular involvement with COVID-19 deserve much more detailed research, and quickly. As further research and developments related to this issue evolve, we will update these recommendations as needed.



Biykem Bozkurt, MD, PhD Richard Kovacs, MD, FACC Bob Harrington, MD, FAHA President, HFSA President, ACC President, AHA

References

  1. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med.

2020 Feb 28. doi: 10.1056/NEJMoa2002032

  1. Huang, C. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497–506 (2020).
  2. Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. (2020) Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 395, 565–574 https://doi.org/10.1016/S0140-6736(20)30251-8
  3. Hoffmann M et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor.Cell. 2020 Mar 4. pii: S00928674(20)30229-4. doi: 10.1016/j.cell.2020.02.052.
  4. Ferrario CM et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005 May 24;111(20):2605-10. Epub 2005 May 16.
  5. Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. (August 2005). "A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury". Nature Medicine. 11 (8): 875–9. doi:10.1038/nm1267. PMID 16007097
  6. Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, et al. (July 2005). "Angiotensinconverting enzyme 2 protects from severe acute lung failure". Nature. 436 (7047): 112–6.
  7. Zheng, Y., Ma, Y., Zhang, J. et al. COVID-19 and the cardiovascular system. Nat Rev Cardiol (2020). https://doi.org/10.1038/s41569-020-0360-5

Clinical Topics: Anticoagulation Management, Heart Failure and

Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension

Keywords: ACC Publications, Cardiology Magazine, Coronavirus, Coronavirus Infections,

COVID-19, Peptidyl-Dipeptidase A, Renin-Angiotensin System, Angiotensin Receptor

Antagonists, Angiotensin II, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular

Diseases, Coronavirus, SARS Virus, Pneumonia, Viral, Lung Injury, Angiotensin I, Heart Failure, Peptide Fragments, Vasoconstrictor Agents, Hypertension, Myocardial Ischemia

© 2020 American College of Cardiology Foundation. All rights reserved.

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