Heart Failure & COVID-19: Mitigation Strategies

Transcript: Deepak L. Bhatt, MD, MPH: Hello, and welcome to this HCPLive® Peer Exchange, “Best Practices and Treatment Options to Manage Heart Failure.”

I’m Dr Deepak Bhatt, from Brigham and Women’s Hospital and Harvard Medical School.

Today, to discuss the latest advances in pharmacological therapies for the treatment of heart failure, I’m joined by Dr Nancy Albert, from Cleveland Clinic; Dr George Bakris, from University of Chicago Medicine; Dr Javed Butler, from University of Mississippi Medical Center; and Dr Akshay Desai and Dr Scott Solomon, both from Brigham and Women’s Hospital and Harvard Medical School.

So, without further ado, let’s get started. But before actually getting into heart failure, I should pause. We are in the middle of a pandemic—COVID-19—and it’s hard to really live life as normal, in any respect. Maybe I could just ask each of you your thoughts on COVID-19 and how you’re dealing with it in the hospital and in terms of your families? What are the ramifications for your patients with heart failure? Maybe we’ll start with you, Nancy. What’s going on at Cleveland Clinic?

Nancy M. Albert, PhD, CCNS: We’ve been very busy gearing up for a surge in numbers in Ohio and in Cleveland, specifically. Our leadership has a great plan that we’re putting into place. Nurses are being retrained and upscaled, I guess you could say, to do work that maybe they haven’t done in a long time. It’s a little chaotic. It’s hard for visitors because they can’t come in and visit. I think there are plenty of people who are afraid. There is a fear that goes along with not understanding what to expect. But I would say that, in general, people are dealing with it fairly well. There is really a team spirit and a belief that we’ll get through this together.

Deepak L. Bhatt, MD, MPH: That’s great to hear. George, how about at the University of Chicago? From what I can tell, Chicago was hit pretty hard. As you know, we should have been there this past weekend for the American College of Cardiology Annual Scientific Session & Expo. We did manage to do it virtually. I think it was quite successful. But how are things in Chicago?

George Bakris, MD: Much like they are in Cleveland. Chicago has been hit harder, but not like New York. But all the hospitals here, it’s the same thing as Nancy said—team spirit, everybody is on board. We’re essentially doing all our visits from home with Zoom, and there are shifts going in. Senior fellows have now been recruited to be junior attendings to help with the workload. Rush Health has turned their lobby into something similar to an ICU [intensive care unit]. It was designed to do that, by the way. McCormick Place, where the meetings would have been, actually allocated a part there for beds. So we’re doing everything we can in a very reasonable way. People are working together, and it’s good esprit de corps.

Deepak L. Bhatt, MD, MPH: That’s really terrific to hear. Javed, what’s going on in Mississippi?

Javed Butler, MD, MPH, MBA: This is squarely a department of medicine problem. I’ve been intricately involved in all the planning activities, and all I can say is that we are turning upside down 100 years’ worth of how we practiced medicine to prepare for an emergency, a pandemic, in like a 2-week period. So, a crazy amount of activity has been going on in the hospital. There are some projections that suggest that Mississippi will be either second to Louisiana or worse than Louisiana in terms of impact and mortality. We are sort of in the beginning phase of this. We expect the peak to occur somewhere around the end of April, early May, but an extraordinarily high number of people are getting intubated and are requiring dialysis. So that’s our beginning experience, and it’s very, very humbling.

Deepak L. Bhatt, MD, MPH: Yes, scary to hear those stories from out there. I hope it ends up not being that bad, but I fear that it will. You mentioned the changes that are going on, and it’s interesting. Actually, one of my fellows and I wrote a piece on how COVID-19 will lead to a medical revolution, but in a good way. As George mentioned, telemedicine. This is stuff we probably should have been doing ages ago, but there weren’t really systems set up to do it right. Reimbursement wasn’t aligned to foster it. Of course, these changes are occurring because of COVID-19, but I hope some of them become permanent and really improve our health care system and make it much more functional than it currently is.

Transcript Edited for Clarity