To ensure COVID-19 vaccination priority for the sickest CVD patients, the ACC statement identifies highest risk conditions within CVD to aid clinician decision making.
Patients with advanced cardiovascular disease (CVD) should be prioritized for COVID-19 vaccination over those with well-managed CVD, according to an American College of Cardiology (ACC) policy statement published in the Journal of the American College of Cardiology.
The statement acknowledges that complications from COVID-19 infection are more likely in all patients with CVD but goes on to offer guidance for clinicians on prioritizing the most vulnerable patients within the larger CVD population they see.
The ACC statement also stresses the importance of considering the widespread disparities seen in COVID-19 outcomes among different racial and ethic groups and across socioeconomic levels and calls for consideration of these disparities in vaccine allocation decisions.
Phase 1c of the Center for Disease Control and Prevention’s (CDC) vaccine prioritization guidance calls for all patients aged 16 to 64 years with medical conditions that increase the risk for severe COVID-19 infection to receive the vaccine. Conditions listed include heart disease, hypertension, diabetes, obesity, and smoking. The ACC writing committee notes, however, that “further delineation of varying levels of risk among patients with cardiovascular disease (CVD) is absent.”
"A coherent vaccine allocation strategy will consider the exposure risks and clinical risks of given individuals and populations," said Thomas M. Maddox, MD, MSc, ACC writing committee cochair, in an ACC news release. “In addition, it will take into account those demographic populations that, for a variety of reasons, have additional risks that lead to higher rates of COVID-19 infection and severe health outcomes."
The ACC writing group convened included expertise in CVD, epidemiology, and risk assessment. A literature review was performed of published reports relating to CVD and COVID-19 and included data from geographically diverse areas. The authors note that most of the data published are retrospective and that their recommendations are based on the limited data collected since the pandemic began.
The final proposed vaccine allocation schema outlines key CV clinical risk considerations within the broader context of key overall risk considerations including exposure, disparities, health care access, advanced age, and multimorbidity.
An individual’s risk should be determined by their highest-risk CV condition, as follows: