COVID-19: Cardiology service guide

May 2020

Scope

This information provides guidance on the management of cardiology patients across Northern Devon during the Covid-19 pandemic. The information is based on national guidance from NHS England and the British Cardiovascular Society, including affiliated societies.

National guidance

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

Clinical guide for the management of remote consultations and remote working in secondary care during the coronavirus pandemic

​2WW referrals

  • Chest pain, considered to be related to angina
  • Total Loss of Consciousness (without typical vaso-vagal features)
  • 'High-risk' heart failure (new presentation, with nt-pro-BNP level 2000 or higher)
  • Known arrhythmia, with significant deterioration in symptoms (despite recommended medical management)
  • Palpitations, with 'red-flag' features (e.g. palpitations during exercise, with pre-syncope/syncope, high risk structural heart disease, family history of inheritable heart disease/SADS, high degree atrioventricular block)

Conditions with specific guidance

Heart Failure

Patients will be triaged by our team and may be seen in a clinic environment and have an echo (particularly, those with nt-pro-BNP 2000 or higher) to confirm/refute diagnosis, or deferred until a safer time. Advice regarding ongoing management will be provided and where appropriate referral to the Heart Failure Nursing team will be made.

The Heart failure nursing service will continue to provide:

  • Home visits for high risk patients experiencing symptoms of decompensation
  • Telephone follow up and advice
  • Triage of newly discharged patients to either telephone/face to face follow up

Please note, we will be adjusting only those medications where we feel this is likely to prevent or treat a period of decompensation and subsequently avoid hospital admission.

We are not titrating routine heart failure therapies, where this would require face to face monitoring.

Please feel free to contact our team if you are aware of any patients, under your care, who are experiencing symptomatic heart failure (due to reduced LV function), of whom we may not be aware. We would be happy to offer advice and/or assessment as required.

We would also be happy to provide advice (only) for diuretic management in those patients who have heart failure, but preserved LV function.

Urgent referrals

Refer conditions above as urgent, Consultant Cardiology Team will review and determine the type of consultation required:

  1. Telephone consultation
  2. Video consultation
  3. Face to face appointment
  4. Defer with advice and guidance
If in doubt during the COVID-19 pandemic the cardiology teams are happy to be contacted for advice. Please see contact information, for further details

​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

Please call the Trust Cardiology department tel: 01271 314131 or, for urgent queries, the Cardiologist of the Week (COW) via NDDH switchboard Tel: (01271) 322577

​Advice & Guidance/Telemedicine services

Please see 4. above in urgent referrals.

If concerned about a patient please contact the relevant clinical team.

COVID-19 Particularly high risk patient advice

Even if not at extremely high risk, we have reiterated the importance of staying at home apart from essential needs as per current advice, as patients may still be at particularly high risk because of their heart condition. In particular, that they may be at high risk if:

  • Heart disease and over 70
  • Heart disease and lung disease/chronic kidney disease
  • Angina that restricts daily life or means you having to use GTN frequently
  • Heart failure, especially if it restricts daily life or admission to hospital, to treat heart failure, in the past year
  • Heart valve disease that is severe and associated with symptoms (such as regularly breathlessness, or from heart valve problems despite medication, or awaiting valve surgery)
  • Recovering from recent open-heart surgery in the last 3 months (including heart bypass surgery)
  • Cardiomyopathy (any type) if symptoms such as breathlessness, or it limits daily life
  • Congenital heart disease (any type), with any of the following: lung disease, pulmonary hypertension, heart failure, over 70 years, pregnancy, or complex congenital heart disease (such as Fontan, single ventricle or cyanosis).

We would wish, to highlight the concerns of the heart failure professional body regarding the lack of shielding advice for patients living with heart failure. As a result, we have advised patients living with heart failure that they fit in to the category of a vulnerable adult and should strictly comply with social distancing for at least 12 weeks; where requested, we have written letters for them to share with their employers.

North Devon Healthcare Trust contact information

  • Cardiology Consultants: Dr Christopher Gibbs, Dr Dushen Tharamaratnam, Dr Rahul Potluri, Dr Sujoy Roy (Locum)
  • Heart Failure: Angela Tithecott, Poppy Brooks, Rebecca Nicholls, Robert Hall, Justine Aggett
  • Arrhythmia Care: Sarah Bryant, Gemma Baker
  • Cardiac Rehabilitation: Kimberley Endacott, Lisa Pereira-Marques
  • Cardio-Respiratory Department: Christine Pope and team

General Cardiology queries telephone: 01271 314131

Heart Failure telephone: 01271 314058 or bleep 373 via NDDH switchboard Tel: (01271) 322577

Arrhythmia Care, Cardiac Rehabilitation and Heart Failure telephone: 01271 311633

Cardio-Respiratory Department telephone: 01271 322475

Cardiologist of the Week (COW) via NDDH switchboard telephone: (01271) 322577

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 > Northern CRGs > COVID-19: Cardiology service guide

 

  • First line
  • Second line
  • Specialist
  • Hospital