COVID-19: Cardiology service guide

Updated January 2021

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

Please continue to refer patients to suspected heart failure clinic with raised NTproBNP. Referrals will be triaged by a Consultant and patients continue to be offered a face to face review and echocardiogram. We aim to see those with NTproBNP greater than 2000 within 2 weeks.

For patients with heart failure secondary to reduced ejection fraction (HFrEF), the heart failure service will continue to provide:

  • Home visits for high risk patients experiencing symptoms of decompensation
  • Routine telephone, video and face to face follow up appointments as per waiting list.
  • Telephone advice line available to patients Mon-Fri 9am to 5pm
  • Triage of newly discharged patients (with heart failure secondary to reduced ejection fraction )to either telephone/face to face follow up within two weeks of hospital discharge
  • Heart failure in-patient service (bleep 373)

In line with British Society for Heart Failure (BSH) pandemic recovery recommendations, we continue to titrate routine heart failure therapies due to their life-prolonging effects. A further period of ceasing this activity would adversely affect individual patients and also increase local heart failure admissions. It is therefore paramount that we continue this area of our service unless there comes a time when local healthcare infrastructure is not able to support the continuation of such activity.

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

New Routine referrals will not be prioritised during the COVID-19 Pandemic but we will aim to arrange appointments for those patients as soon as possible whilst prioritising the urgent referrals. These referrals will be triaged as appropriate by a Consultant and will be offered a telephone/video consult, face to face consult or guidance as appropriate.

Outpatient investigations such as holter monitors and echocardiograms will be prioritised as per the clinical need and will be offered appointments when possible. Due to COVID-19 and the changes in the organisation and scheduling of these appointments, there may be a waiting period for some of these investigations which will be evaluated and addressed periodically.

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 Ashok Tahilyani (Locum)
  • Heart Failure: Angela Tithecott, Poppy Brooks, Rebecca Nicholls, Faye Windsor, Robert Hall, Justine Aggett
  • Arrhythmia Care: Sarah Bryant, Gemma Baker and Andrew Chiles
  • Cardiac Rehabilitation: Lisa Pereira-Marques and Anita Griggs
  • Cardio-Respiratory Department: Sally-Anne Pester 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

Supporting Information

GP Information

British Society for Heart Failure - Evaluation of Symptomatic Heart Failure patients as HIGH RISK for COVID-19

A Position Statement from the British Society for Heart Failure: Retention of Essential Heart Failure Services during COVID-19 Pandemic

British Congenital Cardiac Association COVID-19 guidance for extremely vulnerable groups with congenital heart disease

Patient Information

Heart Matters - Coronavirus and you

Heart Matters - Coronavirus Information & Support if you have congenital heart disease

Heart Matters - Coronavirus Information & Support if you have heart or circulatory disease

Evidence

British Cardiovascular Society

Pathway Group

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

Publication Date: April 2020

Date updated: January 2021

Pathway Group

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

Publication Date: April 2020

Date updated: January 2021

Last updated: 20-01-2021

 

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