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Cardiologist advice for Australians with heart risks in evolving COVID-19 situation

Cardiologist, Professor Jepson, urges people with cardiovascular risk issues to take more control of their situation.

Getting to the heart of Covid-19

Advice for Australians with heart risk factors in evolving situation, from Professor Nigel Jepson, medical director of Eastern Heart Clinic, Randwick, NSW. Professor Jepson's summary is:

· That Australia [...] ‘must increase vigilance and adopt even stricter measures’ to avoid the trajectory [that COVID-19] has taken in Northern Italy,’ says Professor Nigel Jepson, interventional cardiologist at Prince of Wales Hospital and Medical Director of Eastern Heart Clinic, Randwick NSW.

· Particularly vulnerable are the 1.2 million Australians currently living with cardiovascular disease (CVD);[1] more than 1 in 4 (26%) of those aged 75 and over have heart, stroke and vascular disease.[2]2

· This group and people with other conditions that affect the heart and vascular system, such as high blood pressure, chronic respiratory disease and diabetes, are at elevated risk of developing complications if they contract COVID-19.3 In an ordinary year, CVD already leads to an average of more than 1 million hospitalisations.2

· In addition to following the Government’s advice on social distancing and hygiene, Prof Jepson advises that people with CVD should start following ‘heightened’ measures(below).

· ‘We can see from the data in Wuhan that patients with an underlying heart condition may not be more likely to become infected in the first place but are at higher risk of developing complications including breathing problems, abnormal heart rhythms or, ultimately, heart failure, than others,’ says Prof Jepson. This increased risk of death for people with CVD is estimated to be nearly 10% higher than a ‘healthy’ patient.[3]

· ‘We don’t want to create fear or panic but I don’t think we’re really getting the message across that, while for most of us COVID-19 would be an innocuous disease to get, we need to adopt caution and care to slow the rate of spread as much as possible, in order to protect those who could be more seriously affected.

· ‘We also want to avoid clogging up hospitals. It makes no sense to say, ‘Let’s all get it now, and get it over with’ - that’s nonsensical and dangerous - because we need the emergency beds, equipment and personnel for acute COVID-19 patients or any other person requiring emergency medical care, or we will find ourselves buckling under the pressure, like the health services in Lombardy (northern Italy)’.

· New Italian data released at the weekend shows higher death rates than in China, Iran or Korea.[4] The precise reasons for the higher rates are not clear, but it is thought that very rapid community spread of COVID-19 and a saturated health system were at least significant contributors.

10 WAYS PEOPLE WITH HEART ISSUES CAN REDUCE THEIR COVID-19 RISK:

1. Avoid large gatherings (even contexts with fewer than 500 people) e.g theatres, cinemas, concerts and shopping centres [Candobetter Editor says, Oh, come on, Prof Jepson, stop the pussyfooting, surely you mean much smaller crowds, to wit, avoid groups.]

2. Exercise caution when using public transport - avoid busy times and routes in known outbreak areas; make alternative travel arrangements

3. Do not travel unnecessarily - avoid airports, train stations and bus terminals

4. Go shopping at quiet times- or take advantage of major supermarkets’ time slots for older people only

5. Have your prescriptions for heart medicines filled now – ask your pharmacist and GP to assist as shortages are occurring in some areas

6. Postpone non-urgent medical appointments or procedures - or consult your healthcare professional by phone or ‘telehealth’ instead

7. Stock up on groceries (within reason) – you’re going to be at home more, so organise for online deliveries (friends and family can help)

8. Get vaccinated – stick to plans to be vaccinated for influenza and pneumonia, and others as your doctor advises, to avoid developing other conditions that can be confused with coronavirus (such as flu)

9. Stay healthy - eat well, get enough sleep and follow exercise regimens as advised by your healthcare professionals

10. Keep calm and carry on - if you live alone, think about low-risk activities you can do to socialise, such as meeting a friend outdoors for a walk

Professor Nigel Jepson is the medical director of Eastern Heart Clinic, one of the largest interventional cardiology hospitals in Australia, based at the Prince of Wales Hospital at Randwick. He is also a senior staff cardiologist at the Prince of Wales Hospital, where he established the unit’s trans-catheter aortic valve program.

References:

1. ABS. https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001

2. AIHW. https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease

3. Chinese Center for Disease Control and Prevention, CCDC Weekly, Vol 2, No. 8

4. World Health Organisation Situation Reports 16 March 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200316-sitrep-56-covid-19.pdf?sfvrsn=9fda7db2_2

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