Clinical Scorecard: Guidelines for the Prevention and Management of Cardiovascular Disease in the Context of COVID-19: A Consensus from Leading European Cardiovascular Associations

At a Glance

Key Highlights

• COVID-19 can trigger and exacerbate cardiovascular complications during acute and post-acute phases, including Long COVID.
• Over 20% of Long COVID patients experience cardiac symptoms such as angina, arrhythmias, heart failure, and autonomic dysfunction.
• Early and proactive cardiovascular prevention and rehabilitation are essential to mitigate risks and improve outcomes.

Guideline-Based Recommendations

Diagnosis

• Recognize cardiovascular complications including myocarditis, pericarditis, thrombotic events, arrhythmias, and heart failure during and after COVID-19 infection.
• Identify Cardiac Long COVID by new cardiovascular symptoms persisting beyond 2 months post-infection with no alternative explanation.
• Use biomarkers such as troponin and NTProBNP to assess cardiac injury.

Management

• Implement targeted cardiovascular prevention strategies early after acute COVID-19 infection.
• Provide personalized therapeutic approaches including lifestyle modifications and cardiovascular rehabilitation.
• Avoid unproven treatments to prevent harm from invasive interventions or adverse effects.

Monitoring & Follow-up

• Monitor patients with elevated cardiac injury markers and those with pre-existing cardiovascular disease closely.
• Assess for persistent or new cardiovascular symptoms in Long COVID patients.
• Adjust management plans based on evolving clinical status and emerging evidence.

Risks

• Increased risk of myocarditis, myocardial infarction, thromboembolism, arrhythmias, and heart failure post-COVID-19.
• Potential adverse cardiac effects from corticosteroid treatment during acute infection.
• Exacerbation of cardiovascular risk factors and comorbidities by COVID-19 infection.

Patient & Prescribing Data

Patients with acute or prior COVID-19 infection, including those with Long COVID and pre-existing cardiovascular disease

Corticosteroids benefit acute infection but may adversely affect cardiac physiology; vaccines reduce morbidity and mortality but cardiovascular risk persists; personalized treatment and rehabilitation improve outcomes.

Clinical Best Practices

• Early identification and management of cardiovascular complications in COVID-19 patients.
• Use of biomarkers to stratify cardiovascular risk post-infection.
• Implementation of lifestyle modifications and tailored cardiovascular rehabilitation programs.
• Avoidance of unproven and potentially harmful treatments.
• Ongoing research and individualized preventive strategies to address evolving evidence.

References

• World Health Organization definition of Long COVID
• European Society of Cardiology COVID-19 Cardiovascular Guidance