Table 5.1. Recommendations for COVID-19 management in heart failure patients.

Recommendations	Class	LE	Comments	Table 2018	Ref.
RT-PCR testing for SARS-CoV-2 in individuals with chronic HF and acute respiratory symptoms.	I	C	NEW: Editorials and society recommendations (online publication).	New	46,47
ACEI, ARB or ARNI maintenance in HF patients who develop COVID-19, in the absence of hypotension or other signs of hemodynamic impairment.	I	C	NEW: Controlled observational studies with large numbers of participants, but a smaller number of HF patients.	New	48–50
Outpatient follow-up of HF through remote appointments (telemedicine and telemonitoring) during the COVID-19 pandemic.	I	C	NEW: Experts and Society recommendations	New	51,52
Considering COVID-19 symptoms can simulate decompensated HF, RT-PCR testing for SARS-CoV-2 is recommended for patients seeking medical care in the emergency department or outpatient clinic setting.46,47 There is no evidence for routine discontinuation of ACE inhibitors, ARBs or ARNI in patients with symptomatic HF diagnosed with COVID-19. Decisions to add or remove these medications should be guided by standard clinical practice, and individualized treatment decisions should be made according to each patient's hemodynamic status and clinical presentation.48–50 Online and/or remote tools (phone calls, telemonitoring, online appointments, and video calls, among others) may be used to keep continuous care for HF patients during the COVID-19 pandemic. These actions that are useful to reduce patients' virus exposure, has being effective for usual care, and are expected to endure in the post-pandemic world. For patients with clinical instability (post-discharge for HF decompensation or recent-onset HF) and candidates for advanced HF therapies (transplantation or ventricular assistant devices), we recommend at least one in-person appointment, in between virtual visits, especially considering the pandemic tends to decrease the number of transplants performed, and to increase the waiting-list period of time.51,52

ACEI: angiotensin-converting enzyme II inhibitors; ARB: angiotensin II receptor blocker; ARNI: angiotensin II receptor-neprilysin inhibitor; HF: heart failure.