COVID-19: Cardiology service guide

May 2020

Scope

This information provides guidance on the management of cardiology patients by the Royal Devon and Exeter NHS Foundation Trust during the Covid-19 pandemic. The information does not replace clinical judgement and is accurate as of the above date but is subject to change without notice.

National guidance

Clinical guide for the management of cardiology patients during the coronavirus pandemic

​2WW referrals

Nurse lead rapid access chest pain clinic:

  • If considering a diagnosis of angina then usual referral criteria currently apply
  • All patients will initially be assessed by phone consultation
  • If possible, sending through an ECG would be extremely helpful
  • Subsequent investigation will be severely curtailed and only if patients have refractory symptoms
  • Please start all patients on a statin, betablocker and consider aspirin

Conditions with specific guidance

Cardiac Investigations

  • All are currently restricted with only urgent tests continuing when indicated
  • Please defer referral for non-invasive investigations unless urgent

Heart Failure

  • The diagnosis may need to be clinical until there is provision for routine echocardiography. Use NTproBNP to help diagnosis and risk assessment
  • All efforts should be made to manage symptoms or fluid overload at home with increasing doses of loop diuretic. Adding a thiazide diuretic or spironolactone may be useful
  • Patients with refractory symptoms can initially be discussed via the same day consultant electronic advice and guidance service (see below)
  • Referrals can still be made for patients not responding to treatment. Particularly in those with NTproBNP greater than 2000ng/L. These will be triaged and a proportion can be brought to clinic if really necessary
  • The community heart failure nursing team are still managing their current caseload (predominantly by phone but when needed by home visit) and can accept new referrals as usual once an echocardiogram has confirmed LV systolic dysfunction

Cardiac Rehabilitation

  • Nurse lead follow up is continuing with phone consultation following coronary revascularisation and acute coronary syndromes.
  • An online resource for patients is being offered to support home based rehabilitation

​Urgent referrals

  • Patients with unstable and/or life threatening symptoms can still be referred for hospital treatment/admission as usual
  • Consider using the electronic Advice and Guidance service as a rapid way to manage any urgent outpatient problem (see below)
  • Urgent outpatient referrals can still be made in the usual way but please explain the urgency and why the patient needs to be seen or managed despite the COVID-19 restrictions
  • By default all appointments will be phone consultation. Please highlight any reason why this should not be the case

​Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Urgent advice

  • We are currently offering an enhanced consultant electronic advice and guidance service 9am-5pm 7 days a week.
  • Access is as usual via the electronic system.
  • Please use this method for all urgent cardiology queries.
  • If you think that a telephone conversation would help improve care, avoid hospital admission or direct onward care more appropriately, then please include a mobile phone number and a request for a call-back in addition to the clinical history.

​Advice & Guidance

  • We are currently offering an enhanced consultant electronic advice and guidance service 9am-5pm 7 days a week.
  • Access is as usual via the electronic system.
  • Please use this method for all urgent cardiology queries.
  • If you think that a telephone conversation would help improve care, avoid hospital admission or direct onward care more appropriately, then please include a mobile phone number and a request for a call-back in addition to the clinical history

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 04-05-2020

 

Home > Refer-CV19 CRGs > Eastern CRGs > COVID-19: Cardiology service guide

 

  • First line
  • Second line
  • Specialist
  • Hospital