ACC Policy Statement on COVID-19 Vaccination Prioritization Based on CVD Considerations

The American College of Cardiology (ACC) published a policy position statement in the Journal of the American College of Cardiology, regarding prioritization and allocation of coronavirus disease 2019 (COVID-19) vaccine, with a focus on cardiovascular disease (CVD).

This strategic guidance emphasizes the need to consider both individual- and population-level of risk for exposure to and outcomes of COVID-19. The most beneficial policy would prioritize access to COVID-19 vaccines to those at greatest risk for related adverse outcomes.

Despite current official instructions that adults with comorbidities (ie, CVD, hypertension, obesity, diabetes, smoking) that have been associated with a higher risk for severe COVID-19 complications, be prioritized for inoculation (phase 1c), there is no further delineation for patients with CVD. The ACC writing committee that includes experts in CVD, risk assessment and epidemiology, sought to provide specific clinical guidance, based on literature reviews and/or group consensus, based on COVID-19 adverse outcomes associated with specific CVDs, and proposed a CV risk scheme to support vaccine allocation decision-making.

The risk for severe COVID-19 infection has been associated with advanced age and a set of preexisting conditions. Frailty, worse healthcare accessibility, and higher-risk racial/ethnic and socioeconomic groups should also be considered when planning for vaccine allocation.

Among patients hospitalized for COVID-19, the most common comorbidities, with prevalence ranging from 15% to 50%, are obesity, hypertension and diabetes mellitus (DM), all of which are associated with elevated mortality risks. Less common comorbidities associated with greater risks from COVID-10 (prevalence, 5%-10%) include heart failure (HF) and atherosclerotic CVD (ASCVD). There is increasing evidence supporting the notion that pulmonary hypertension, adult congenital heart disease, pre-existing arrhythmia, and a history of heart transplant are also associated with increased risks for death in patients with COVID-19.

Severity and level of control of individual comorbidities also affect outcomes in patients with COVID-19. The ACC therefore offered a vaccine allocation scheme prioritizing patients with more advanced (eg, patients with symptomatic ASCVD, poor glycemic control, or frequent arrhythmia) vs better managed or less symptomatic CVD.

The writing group acknowledges that there have been sizeable challenges and obstacles to vaccination efforts across the United States and its myriad healthcare systems, and that adding the complexity of trying to account for poorly codified CVD severity would likely only further complicate this endeavor. The hope is that this policy statement will provide clinicians a reference for advising their patients about individual COVID-19-associated risk.

“Our 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. Individual risk should be determined by their highest-risk CV condition,” noted the authors. “We hope that this document can be used to guide COVID-19 vaccine allocation and patient outreach in the context of prolonged demand-supply mismatch as we enter Phase 1c.”

Funding and Conflicts of Interest Disclosures:

Please see original article for conflict-of-interest declarations.

Reference

Driggin E, Morris AA, Maddox TM, et al. ACC health policy statement on cardiovascular disease considerations for COVID-19 vaccine prioritization: a report of the ACC Solution Set Oversight Committee. J Am Coll Cardiol. February 2021. doi:10.1016/j.jacc.2021.02.017