Clinical distancing of patients with advanced HF, transplant may protect against COVID-19
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One hospital system protected its patients with advanced HF and cardiac transplant from COVID-19 by safely moving them from a central hospital, which was redesigned to care for patients with COVID-19, to a cardiac specialty hospital with no patients with COVID-19, according to a paper published in The Journal of Heart and Lung Transplantation.
“It is important to underscore the point that all decisions were patient-centric,” Mary Norine Walsh, MD, MACC, medical director of heart failure and transplantation at St. Vincent Heart Center in Indianapolis and past president of the American College of Cardiology, told Healio. “Protection of a vulnerable population was and continues to be the goal.”
A recent brief report in JAMA Cardiology highlighted that recipients of heart transplants who contract COVID-19 are at high risk for poor outcomes. Among 28 patients (median age, 64 years, 79% men), death occurred in 25%. Of the 79% of patients who were admitted, 50% were discharged, 32% died during hospitalization and 18% remained hospitalized at the end of the study.
“The high case-fatality rate in this cohort calls for close monitoring of recipients of heart transplant and a low threshold for hospitalization during acute infection with COVID-19,” Farhana Latif, MD, assistant professor of medicine at Columbia University Irving Medical Center, and colleagues wrote.
Transporting patients
Before the COVID-19 pandemic, patients with advanced HF and cardiac transplant underwent care at the central hospital of the Ascension health care organization, which included 825 beds for short-term acute care and was the main facility where heart transplantation was performed, according to the paper by Walsh and colleagues. Plans were in place to convert the central hospital to care for patients with COVID-19, which prompted the decision to move patients with advanced HF or a heart transplant to a 107-bed cardiac specialty hospital that was 5.5 miles away to protect these vulnerable patients from potential exposure to SARS-CoV-2.
“Our primary transplant hospital anticipated a surge of patients with COVID-19 infection, many of whom might require medical ICU support,” Walsh, a member of the Cardiology Today Editorial Board, said in an interview. “In the planning for this surge, it was clear that our transplant patients would likely be at less risk at our system’s cardiac specialty hospital that had admitted no known COVID-19 patients.”
This specialty hospital in the Ascension system operated on a single-bed concept so patients can stay in the same bed throughout the course of their hospital stay. The entire spectrum of care could be delivered in the room, including perioperative and intensive care, hemodynamic monitoring, and complete device and cardiac management, according to the paper by Walsh and colleagues.
The decision was made on March 31 by the United Network for Organ Sharing (UNOS) Membership and Professional Standards Committee to temporarily change the location of the cardiac transplantation program to the specialty hospital. Other patients were also moved, including one with severe rejection, one awaiting transplant and other patients who required ICU care due to recent ventricular assist device implantation or device complications. All patients were moved to the specialty hospital without worsening illness or complication, Walsh and colleagues wrote.
“The patients who were moved were all stable at the time of ambulance transfer,” Walsh told Healio. “All were accompanied by experienced transplant and heart failure ICU professionals.”
Walsh said the plan also involved transferring staff to the specialty hospital.
“In addition to the advanced heart failure and transplant cardiologists and nurse practitioners who shifted to our campus, critical care transplant nursing staff were reassigned to the cardiac specialty hospital in order to provide seamless care to our patients,” she said. “The PharmD and physical therapy staff who work with our patients shifted as well.”
Several rules have been implemented regarding where patients would be admitted. For example, patients posttransplant and those with ventricular assist devices without COVID-19 would be admitted to the specialty hospital, whereas those with COVID-19 symptoms or patients under investigation would be admitted to the central hospital. In addition, all patients requiring neurosurgical evaluation or with trauma would be admitted to the central hospital.
Since patients and services were moved, one patient underwent successful cardiac transplantation at the specialty hospital, according to the paper.
Protective measures are also being taken by employees at the specialty hospital, including daily screening for self-reported symptoms and availability of personal protective equipment. The specialty hospital has also implemented a no-visitor policy.
‘Monitoring phase’
Walsh said her team is “currently in a monitoring phase” regarding future plans.
“As the number of COVID-19 patients declines in our state and in our primary transplant hospital, we are beginning to admit advanced heart failure patients to our primary campus again. We do not intend to move any patients back to the primary campus. They will remain in the cardiac specialty hospital until discharge.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio. – by Darlene Dobkowski
For more information:
Mary Norine Walsh, MD, MACC, can be reached at macwalsh@iquest.net; Twitter: @minnowwalsh.
Disclosures: The authors of the paper in The Journal of Heart and Lung Transplantation and Latif report no relevant financial disclosures. Please see the JAMA Cardiology study for all other authors’ relevant financial disclosures.
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Latif F, et al. JAMA Cardiol. 2020;doi:10.1001/jamacardio.2020.2159.
Walsh MN, et al. J Heart Lung Transplant. 2020;doi:10.1016/j.healun.2020.04.024.
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