Get Vaccinated! Cardiac Disease Puts You at Higher Risk for COVID-19

From the early days of the COVID-19 pandemic, there was strong evidence that people with underlying cardiovascular disease were at higher risk of having a complicated course if they contracted the coronavirus. This has held true as we now have over a year of data on the natural history of the virus. Given this, people with underlying cardiovascular disease should be prioritized for the COVID 19 vaccine. The CDC recommendations on vaccination have recognized this. The American College of Cardiology (ACC), in a recent health policy statement, has echoed this and argued for a more inclusive list of cardiac conditions to be included in vaccine prioritization beyond those enumerated by the CDC guidelines.

The ACC has proposed that patients with the cardiac conditions below are at higher risk of morbidity and mortality from COVID 19 infection. It is also important to note that patients with more than one underlying cardiac condition have a progressively higher risk.

List of Cardiac Conditions Included in Vaccine Prioritization

If you have one or more of these diagnoses, you are strongly encouraged to get the COVID 19 vaccine to reduce your risk of severe illness and death from COVID 19.

Hypertension (i.e., High Blood Pressure)

Multiple large studies from around the world have shown that people with pre-existing hypertension have worse outcomes. These studies have also shown that those with “severe hypertension” do worse. However, the definition of “severe” in this case has been poorly elucidated. In practice, we are defining “severe hypertension” as poorly controlled high blood pressure either because of lack of treatment or ineffective treatment.

Coronary Artery Disease (CAD) and Peripheral Arterial Disease (PAD)

Again, there have been multiple cohort studies from the United States and Chila that have shown that pre-existing CAD or PAD increases the chances of a complicated course with COVID 19 requiring the need for intubation (i.e., a breathing tube) and/or death from the virus. We also know that patients with more extensive coronary artery disease or peripheral artery disease, or untreated disease have worse outcomes.

Cardiac Arrhythmias

The CDC has not listed cardiac arrhythmia as an underlying condition putting patients at higher risk for COVID 19. However, it is the opinion of the ACC and most cardiologists that this should in fact be a qualifying condition in certain patients, given that COVID infection can exacerbate pre-existing arrhythmias. In the case of patients with atrial fibrillation (Afib), for example, those who have a history of tachycardia-induced heart failure or exacerbation of underlying heart failure when they are in Afib are at higher risk. For patients with a history of ventricular arrhythmias – ventricular tachycardia or ventricular fibrillation – there is little data to guide policymakers or cardiologists.

However, an infection like COVID 19, which can reduce a patient’s blood oxygen level has the potential to cause ventricular arrhythmias. Therefore, patients with a history of recurrent ventricular arrhythmias or those who rely on chronic medications to suppress ventricular arrhythmias are likely at higher risk of a poor outcome from COVID and should be prioritized in vaccination plans.

Heart Failure

It is very clear from available data that patients with heart failure have a much higher risk of death from COVID 19 – as much as 30% vs. 6% risk in patients with heart failure vs. those without in some cohort studies (Harrison et al., Plos Med. 2020;17:e1003321). This risk is greater in patients with preexisting decompensated heart failure and those with a poor functional status at baseline. All patients with heart failure should prioritize getting the COVID 19 vaccine.

Conclusion

As always, if you have questions about your risk of COVID-19 in light of your cardiac diagnoses or have questions about the COVID 19 vaccine, please do not hesitate to reach out to your doctor at Cardiocare.

As of this writing, all patients in DC, Maryland, and Virginia over the age of 16 are eligible for the vaccine. You can visit your local Department of Health Website for instructions on how to register and sign up for a vaccine appointment.