Journal CME, July 2022: Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Cardiovascular Complications in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)-Journal CME. July 2022: Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

Journal CME. July 2022: Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

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The document is a multidisciplinary collaborative consensus guidance statement on evaluating and treating cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC). PASC can manifest with various disabling symptoms persisting or starting four or more weeks after the acute infection. Common symptoms include fatigue, shortness of breath, chest pain, palpitations, cognitive dysfunction, and anxiety. PASC symptoms are not limited to individuals who exhibited acute COVID-19 symptoms; they can appear weeks to months post-infection.<br /><br />The guidance highlights that cardiovascular symptoms can vary significantly among PASC patients, ranging from mild to incapacitating. Despite the prevalence, there's limited guidance on assessing and treating these complications. Therefore, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) convened a Multi-Disciplinary PASC Collaborative to develop consensus-based recommendations.<br /><br />Methods included an iterative, modified Delphi process involving established PASC centers and experienced clinicians. Emphasis was placed on health equity, acknowledging disparities in care and outcomes.<br /><br />The guidance statement recommends a detailed patient history, focusing on cardiovascular symptoms such as chest pain, palpitations, dyspnea, fatigue, and dizziness. Initial evaluations should include physical exams and lab workups like complete blood count, metabolic panel, and specific cardiovascular markers like troponin and BNP. Cardiac monitoring, including EKG, echocardiograms, and ambulatory rhythm monitoring, is suggested.<br /><br />Specific management strategies for PASC-related cardiovascular issues include:<br />1. Risk factor modification: addressing hypertension, dyslipidemia, diabetes, obesity, tobacco use, and sedentary behavior.<br />2. Arrhythmia management: in collaboration with cardiologists for complex cases.<br />3. Coronary artery disease and coronary syndromes: managing new or worsened conditions.<br />4. Structural heart disease and heart failure: providing comprehensive care and referrals to cardiologists.<br />5. Cardiac rehabilitation: for individuals with qualifying cardiovascular conditions like myocardial infarction, heart surgery, and heart failure.<br /><br />The guidance also includes considerations for athletes and their return to play, emphasizing a gradual approach based on symptom response and periodic reassessments.<br /><br />Health equity is a central theme, advocating for fair access to care regardless of social or economic barriers, and recognizing the need to address disparities in healthcare access for marginalized populations. The document underscores the necessity for systematic studies and evidence-based approaches to optimize patient care for PASC-related cardiovascular complications.

Keywords

PASC

cardiovascular complications

SARS-CoV-2

fatigue

shortness of breath

AAPM&R

Delphi process

health equity

cardiac rehabilitation

risk factor modification