key: cord-1015081-6vserf6t authors: Panjrath, Gurusher S.; Krepp, Joseph title: COVID-19 and Heart Failure: Harsh Reality of Pre-Existing Conditions date: 2020-11-17 journal: J Am Coll Cardiol DOI: 10.1016/j.jacc.2020.09.588 sha: 1777d7ecfe8a302717735b0aefcf62106b81aca9 doc_id: 1015081 cord_uid: 6vserf6t [Figure: see text] As the recognition of high-risk populations continues to emerge and attempts to understand the mechanism of injury are underway, efforts need to be made on the safe and timely delivery of care to the high-risk groups. Prevention should be the initial step to minimize exposure and provide timely care to patients with heart failure. That there is a delay in getting treatment and fewer clinic visits, which further affects outcomes, is already known (10, 11) . To this regard, greater use of telemedicine may be useful and has transformed the delivery of care paradigm in the evolving health care environment (12) . However, wide adoption would require overcoming barriers to equitable access to basic technology, education, and remote monitoring tools among at-risk communities. Surprisingly, in the current report, race did not appear to be a factor associated with prognosis among the patients with heart failure. This is in contrast to several other reports, albeit in a general population with a predisposition for infection and worse outcomes among African Americans (7, 13) . The pandemic has rightfully placed significant emphasis on treatment of all patients with SARS-CoV-2, but we need to remind ourselves of another harsh reality: >6 million U.S. adults have heart failure; they represent among the highest risk subset of potential COVID-19 infections and worse outcomes, including a 2-fold risk of death, need for prolonged length of stay, and mechanical intubation (4, 14) . Future efforts need to be made toward further elucidating the mechanism and durability of injury by COVID-19 among patients with antecedent heart failure, instituting widespread prevention, and appropriating triage of suspected infections and resource allocation. This includes timely access to vaccines when available, widespread use of influenza vaccine, and continuation or reinstatement of appropriate guideline-driven medical therapy, as well as timely follow-up and access to telemedicine to reduce the risk of worsened prognosis and to facilitate recovery ( Figure 1 ). As the pandemic continues to ravage communities, pathways for care specific to heart failure care need to be created, keeping in mind pre-existing conditions, and tailored to resources available in the health care systems and the communities they serve. Fair allocation of scarce medical resources in the time of Covid-19 Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention Prognostic impact of prior heart failure in patients hospitalized with COVID-19 Association of troponin levels with mortality in Italian patients hospitalized with coronavirus disease 2019: results of a multicenter study Factors associated with death in critically ill patients with coronavirus disease 2019 in the US Hospitalization and mortality among black patients and white patients with Covid-19 Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases Fewer hospitalizations for acute cardiovascular conditions during the COVID-19 pandemic Reductions in heart failure hospitalizations during the COVID-19 pandemic Virtual visits for care of patients with heart failure in the era of COVID-19: a statement from the Heart Failure Society of America Association of race with mortality among patients hospitalized with coronavirus disease 2019 (COVID-19) at 92 US hospitals Heart disease and stroke statistics-2020 update: a report from the