Table 7.

Recommendations for the management of CVD patients with COVID-19 as suggested from Societies/Organizations/Experts.

Society/Organization/Expert and date issued	Recommendations	Precautions
American College of Cardiology179 6 March 2020	1.Make plans for quickly identifying and isolating cardiovascular patients with COVID-19 symptoms. 2.Advise all cardiovascular patients of the potential increased risk. 3.CVD patients should remain current with vaccinations, including the pneumococcal vaccine. 4.In geographies with active COVID-19 outbreaks, it may be reasonable to substitute telephonic visits for in-person routine. 5.General immunological health remains important for both providers and patients, including eating well, sleeping, and managing stress.	1.Patients with underlying cardiovascular disease are at higher risk of contracting COVID-19 and have a worse prognosis. 2.Classic symptoms and presentation of AMI may be overshadowed in the context of COVID-19, resulting in underdiagnosis. 3.For patients with heart failure or volume overload conditions, copious fluid administration for viral infection should be used cautiously. 4.It is reasonable to triage patients with COVID-19 according to underlying cardiovascular or other comorbid conditions for prioritized treatment.
ESC Council on Hypertension140 13 March 2020	Continuation of treatment with the usual antihypertensive therapy.	No evidence about ACEIs and ARBs in humans; however, preclinical evidence suggests that these medications might be rather protective.
Chinese Medical Association180 27 March 2020	Severe emergent cardiovascular diseases for which hospitalization and conservative medical treatment is recommended: 1.STEMI for whom thrombolytic therapy is indicated 2.STEMI presenting after exceeding the optimal window of time for revascularization 3.High risk NSTE-ACS (GRACE score≥140) 4.Uncomplicated Stanford type B aortic dissection 5.Acute pulmonary embolism, f) acute exacerbation of heart failure, and g) hypertensive emergency Severe cardiovascular diseases requiring urgent or emergent intervention or surgery: 1.Acute STEMI with hemodynamic instability 2.Life-threatening NSTEMI 3.Stanford type A or complex Type B acute aortic dissection 4.Bradyarrhythmia complicated with syncope or unstable hemodynamics 5.Pulmonary embolism presenting with hemodynamic instability for whom regular intravenous thrombolytic therapy might lead to excessively bleeding risk	1.Risk assessment 2.Protection for patients and medical staff 3.Adapting measures tailored to specific local epidemic situations 4.Consider conservative medical treatment as a top priority 5.Intervene in a uniquely equipped cardiac catheterization/electrophysiology laboratory specifically engineered with more than standard disinfection procedures 6.All suspected and confirmed patients with COVID-19 should be transported with standardized attention to relevant national regulations 7.For patients with confirmed or suspected COVID-19 undergoing emergent cardiovascular interventional procedures, preestablished plans for COVID-19 should be initiated 8.Patients diagnosed with COVID-19 should be transferred to an ICU with negative-pressure ventilation for continued treatment 9.Suspected patients with COVID-19 should be isolated in a single bedroom, and suspected infectious specimens should be handled with care
1) Heart Rhythm Society COVID-19 Task Force 2) Electrophysiology Section of the American College of Cardiology 3) Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association181 01 April 2020	1.Triage of procedures based on screening and personal protective equipment. 2.Postpone or cancel non-urgent, elective procedures. 3.Remote device monitoring. 4.Tele-medicine and digital health paradigms. 5.It is reasonable to temporarily stop class III antiarrhythmic drugs, with use of a reasonable alternative if there is evidence of QT prolongation. 6.ECG monitoring should be considered for patients on multiple QT prolonging medications and avoidance or careful monitoring may be required for congenital LQT patients.	1. The proposed HCQ therapy for COVID-19 is relatively short (e.g., 5-10 days), the risk of arrhythmic toxicity is likely quite low. There are specific precautions to be considered for select patients: A Patients with known congenital Long QT Syndrome B Patients with severe renal insufficiency should have the dose reduced (50% for CrCl <10 mL/min) C Patients on QT-prolonging drugs D Electrolyte imbalances must be corrected prior to use None of the above conditions is an absolute contraindication if use of HCQ is warranted. 2.Aggressive electrolyte correction can mitigate arrhythmic toxicity.
European Association of Cardiovascular Imaging182 3 April 2020	1.Cardiac imaging should be performed if appropriate and only if it is likely to substantially change patient management or be lifesaving 2.Use the imaging modality with the best capability to meet the request, but consider also the safety of medical staff regarding exposure 3.Elective non-urgent and routine follow-up exams may be postponed or even cancelled	Obligatory preventive measures during TTE and TOE: 1.Handwashing 2.FFP2/FFP3/N95/N99 masks and gloves 3.Protective clothing 4.Eye protection 5.Head cap 6.Full cover or dedicated scanners 7.Problem-focused study

ACE: angiotensin converting enzyme, ARB: angiotensin II receptor blocker, AMI: acute myocardial infarction, CrCl: creatinine clearance, CVD: cardiovascular, ECMO: extracorporeal membrane oxygenation, ESC: European Society of Cardiology, GRACE score: Global Registry of Acute Coronary Events score. HCQ: Hydroxychloroquine, HFOT: high flow oxygen therapy, NSTEMI: Non-ST-elevation myocardial infarction, PPE: personal protective equipment, STEMI: ST-elevation myocardial infarction, TOE: transesophageal echocardiogram, and TTE: transthoracic echocardiogram.