Richard C. Becker * Journal of Thrombosis and Thrombolysis, 2020
The findings in a nutshell
The author’s view is that the COVID-19 virus causes a variety of health impacts on organs, causing long-term health implications for different parts of the body. The frequency of cardiac injury, vascular dysfunction and thrombosis in patients with COVID-19 (including mild to severe COVID-19 initial presentations) results in a need for a proactive approach to care following hospital discharge and among patients with persisting or new symptoms.
The approach recommended in the review focuses on the need for expertise, standardised procedures and resources from a variety of medical areas, such as infectious diseases, cardiology, vascular medicine, pulmonary medicine, haematology, with components of psychiatry, rheumatology, dermatology, nephology, neurology and immunology included. It is recommended that this should be driven by the goal of prevention, education and communication. The author predicts long-term cardiovascular effects of COVID-19 and advocates for tailored/multidisciplinary cardiovascular management strategies (such as a purpose-designed COVID-19 Cardiovascular Clinic) to help manage the long term and complex impacts of COVID-19.
Implications for Australian workplaces
Insurers, employers, healthcare providers and government should encourage a multidisciplinary, team-based approach. Standardised procedures should be considered to provide the relevant support and enable such strategies to effectively treat and manage the complex medical effects of COVID-19.
Employers can support the wellbeing of employees through knowledge of the many medical effects of COVID-19, by providing flexibility in the workplace that accommodates health monitoring and by making provisions for potential long-term implications.
Overview of paper
This editorial review discusses structural, functional and metabolic abnormalities associated with COVID-19, and suggests management strategies for longer term impacts under the broad clinical umbrella referred to as ‘post COVID-19 syndrome’.
The two main components of the review are:
- The structural and functional effects of COVID-19
- Recommendation of purpose-designed COVID-19 clinics to provide care and monitor changing/ongoing health needs (with a particular emphasis on cardiac care).
The author discusses how COVID-19 can impact all organs structurally and functionally. Persisting problems are common in patients recovering from the virus (including fatigue, shortness of breath, joint pain, chest pain, cough, insomnia and headache). With early detection and close follow-up, these problems can be detected in nearly 90% of patients within a 60 days from original diagnosis. Of particular concern from the author, is the detrimental effects that COVID-19 has on the circulatory system. In particular, the frequency of cardiac injury, vascular dysfunction and thrombosis in patients with COVID-19 raises concern about prolonged recovery periods and potentially long-term cardiovascular effects.
COVID-19-related cardiovascular health events include myocardial infarction (heart attack), hypoxia (shortness of oxygen), hypotension (low blood pressure), distributive shock (abnormal blood flow), coagulopathy (bleeding disorder) and hyperinflammation syndrome (characterised by inflammation, organ dysfunction and fever), reduced left ventricular ejection fraction and kidney disease. The author provides research evidence of COVID-19 related cardiac abnormalities and myocardial infarction mortality rates of 10-25% and poor prognosis for reduced left ventricular ejection fraction (50% will recover, 25% will experience chronic dysfunction and 25% will worsen and require mechanical therapies or heart transplant). Furthermore, and of importance, COVID-19 patients with myocardial injury will remain at risk of cardiovascular events after hospital discharge.
To find out more read the full article here.
Date published: 3 September 2020
Department of Medicine, University of Cincinnati Heart and Circulation Research Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
The author of this paper is from Department of Medicine, University of Cincinnati Heart and Circulation Research Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.