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COVID-19 Vaccines: Prioritizing People With Heart Conditions

CardioSmart News

With more than 2 million deaths worldwide—over 460,000 in the United States—from COVID-19, it’s important to use all tools available to stop the disease from spreading. In addition to wearing a mask, staying 6 feet away from others, and washing hands often, experts recommend getting vaccinated against COVID-19 as soon as possible. This is especially true for people with heart conditions because they have a higher risk of severe illness from the disease.

Vaccine supply is limited, but more doses will become available in the coming weeks and months. Meanwhile, the phased rollout of the vaccine prioritizes older age groups and patients with certain medical conditions who are at increased risk of hospitalization and death from COVID-19. The Centers for Disease Control and Prevention (CDC) recommends that people 16 to 64 years old with underlying health conditions—including heart conditions—be among those who receive the vaccine before the general population.

The American College of Cardiology (ACC) has issued a health policy statement to help guide vaccine distribution among patients with heart conditions until vaccine supply increases. In reviewing the evidence showing that cardiovascular conditions contribute to the risk for adverse outcomes with COVID-19, the statement urges prioritizing the most vulnerable patients. The authors outline a strategy to weigh the risk of certain heart conditions while considering exposure risk, disparities, health care access, advanced age, and the presence of other risk factors and diseases.

The statement encourages people living with heart conditions to know if they are at high risk for severe COVID-19 illness and to prioritize getting vaccinated. It’s important to note that all patients with heart disease have increased risk with COVID-19 and should get the vaccine quickly.

Heart Disease and COVID-19

The ACC statement reviews the evidence showing adverse outcomes associated with certain heart-related risk factors, such as high blood pressure. In a U.S. study of 11,721 patients, high blood pressure was found in 46.7% of patients with COVID-19. Additional studies—one from New York City and a larger one from China—show a higher proportion of people with high blood pressure among those admitted to intensive care units than those who were not. The authors conclude that all patients with high blood pressure should be considered at increased risk for adverse events from COVID-19.

Heart failure is clearly a risk factor for poor outcomes, the authors write. Patients who have symptoms or need to be hospitalized for worsening heart failure should be considered at highest risk, according to the statement. Among a cohort of 31,461 patients with COVID-19 across the U.S., 7.3% had a history of heart failure. And among those who died, there was a higher proportion of those with heart failure compared with those who survived.

People with heart conditions such as atherosclerotic cardiovascular disease (ASCVD) and abnormal heart rhythms should be considered high risk for poor outcomes as well, according to the statement. Having more than one medical condition increases odds of severe illness, too.

The degree of one’s disease—for example well-controlled vs. uncontrolled high blood pressure or non-obstructive vs. obstructive coronary artery disease—also affects the chances of severe illness. When describing the odds of severe COVID-19 based on underlying heart conditions such as ASCVD, the authors examined those nuances of risk. They conclude that those with advanced cardiovascular disease should have priority over those with well-managed disease.

Other Considerations for COVID-19 Risk

But underlying heart and other medical conditions are only part of what’s needed to understand someone’s overall risk. The statement emphasizes the need to consider exposure risk along with clinical risks. The new coronavirus spreads from person to person, so being around other people increases the chance of getting the disease. This exposure risk is tied to how much and how long someone interacts with others. For example, health care workers, first responders, and bus drivers are among those with higher exposure risk because of the nature of their jobs. A person with many medical conditions who requires in-person health visits will have a higher exposure risk as well.

Racial, ethnic, and socioeconomic disparities also factor into increased risk for poor outcomes—including death—from COVID-19. Reports from the CDC show that Blacks and non-Black Hispanics/Latinos had nearly 3 times the risk for death with COVID-19 compared to White/Non-Hispanic persons. There are many reasons for this disparity. It may be in part because members of these populations are more likely to be among essential workers with more exposure risk or to reside in multigenerational households (grandparents, parents, and children living together). In addition, these populations have higher prevalence of existing heart risk factors and disease. Access to medical care also may contribute to this disparity. For example, the number of hospitals and beds in intensive care units tends to be lower where people of color live, and in poor or rural areas, the authors write.

As the vaccine rolls out, the considerations outlined in the ACC health policy can help inform vaccine distribution plans and can serve as a starting point for discussions among clinicians and their patients about overall health and risk of COVID-19 infection. This statement shows how important it is for patients to understand their health status throughout their life journey.

The main message is clear: Get a COVID-19 vaccine as soon as you can—and wear a mask, stay 6 feet away from others, and wash your hands often. All these steps put together will help protect communities against the disease and lead us one step closer to ending the pandemic.

For more information, go to CardioSmart.org/COVID19vaccines. Find links to state health departments at CDC.gov/COVIDVaccine

ACC Health Policy Statement on Cardiovascular Disease Considerations for COVID-19 Vaccine Prioritization,” Journal of the American College of Cardiology, Feb. 12. Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.