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American College of Cardiology says prioritise highest risk heart disease patients for vaccine

In a statement published in the Journal of the American College of Cardiology (JACC), Professor Thomas M Maddox (Washington University School of Medicine, St Louis, USA) and others call for people with advanced cardiovascular disease to be prioritised over those with well-managed disease when it comes to having the COVID-19 vaccine.

Maddox et al note that all people with cardiovascular disease have a higher risk of COVID-19 complications and should receive the vaccine quickly, but they add that they recommend that clinicians prioritise their most vulnerable patients within the larger cardiovascular disease group. Additionally, the authors say consideration should be given to disparities in COVID-19 outcomes among different racial/ethnic groups and socioeconomic levels.

The statement follows guidance from the US Centers for Disease Control and Prevention (CDC) that advocated which populations should get vaccinated first. Under Phase 1c of the CDC guidance, all patients from 16 to 64 years old with medical conditions that increase the risk for severe COVID-19 infection should receive the vaccine. However, while the CDC guidance states that heart conditions — such as high blood pressure (hypertension), diabetes, and obesity — were examples of high-risk medical conditions, it did not review the varying levels of risk among the variety of cardiovascular disease conditions that cardiovascular clinicians manage.

Therefore, in their statement, Maddox et al present specific evidence and risk considerations related to cardiovascular disease and COVID-19. They propose a tiered schema of cardiovascular disease risk to incorporate into vaccine allocation decisions. Furthermore, in their policy statement, they highlight the large disparities in COVID-19 and cardiovascular disease outcomes among racial and ethnic groups and different socioeconomic status levels.

Some examples in the proposed vaccine allocation schema include patients with poorly controlled hypertension, insulin-dependent diabetes, or diabetes with microvascular and/or macrovascular complications as a result of poor glycaemic control should be considered higher risk compared to patients who are medically optimised. Similarly, patients with morbid obesity should be considered higher risk compared to patients who are overweight.

Professor Maddox comments: “Our proposed vaccine allocation schema outlines key cardiovascular clinical risk considerations within the broader context of key overall risk considerations including exposure, disparities, healthcare access, advanced age and multimorbidity. Patients’ risk categorisation is determined by the highest tier in which they meet one or more of its criteria.”

“A coherent vaccine allocation strategy will consider the exposure risks and clinical risks of given individuals and populations. 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,” he adds.

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