Infectious Disease

ACC publishes suggestions for prioritizing COVID-19 vaccines

February 14, 2021

2 min read

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Maddox does not report any relevant financial information. In the declaration you will find all relevant financial information from all other authors.

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According to a health policy statement from the American College of Cardiology, prioritization of COVID-19 vaccines should focus on patients with severe CVD rather than those who are well-treated.

In the statement published in the Journal of the American College of Cardiology, various CVDs have been stratified according to the overall risk of complications from the associated COVID-19 infection.

Covid vaccination

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According to an ACC press release, all patients with CVD are at higher risk of COVID-19 complications and should be vaccinated immediately. However, the ACC statement can serve as a guide for clinicians to prioritize the most at risk patients, taking into account the differences in COVID-19 outcomes among racial / ethnic groups and socio-economic levels.

Thomas M. Maddox

“A coherent strategy for vaccine allocation will take into account the exposure and clinical risks of specific individuals and populations.” Thomas M. Maddox, MD, MSc, Professor of cardiology at Washington University School of Medicine at St. Louis and co-chair of the statement on health policy, said in the press release. “It also takes into account those population groups who for various reasons have additional risks that lead to higher COVID-19 infection rates and serious health consequences.”

In this statement, the ACC writing group provides general exposure and clinical risk considerations necessary for vaccine allocation. Evidence and risk considerations related to CVD and COVID-19; and a tiered scheme of CVD risk to be included in decisions about vaccine allocation.

According to the statement, among the patients at highest risk for COVID-19 outcomes who require prioritized vaccination are those with:

  • recently unplanned hospitalization for CVD;
  • NYHA class III / IV pulmonary hypertension;
  • acute congenital heart disease stage C or D;
  • profound peripheral artery disease;
  • obstructive CAD with one or two vessels and angina pectoris;
  • Triple vessel or left major obstruction CAD;
  • ACC / American Heart Association Level C HF or NYHA Class III / IV HF;
  • ACC / AHA Stage D HF or Heart Transplant;
  • morbid obesity;
  • two or more poorly controlled CV risk factors; and
  • poorly controlled insulin dependent diabetes with or without complications.

The writing committee referred to a meta-analysis that included 21 multinational studies that found CVD to be an independent predictor of serious complications, even after adjusting for age and gender (RR = 1.8; 95% CI, 1.1- 2.7), and a major risk factor was for mortality.

According to the statement, the CDC’s recommendations on the gradual allocation of vaccines prioritize older patients, which is associated with a CVD-related risk. However, the ACC statement recommends that elderly patients with multiple comorbidities, including CVD disease and / or frailty, be prioritized for COVID-19 vaccination.

“We hope this document can be used as a guide for COVID-19 vaccine allocation and patient approach in the context of a persistent supply and demand mismatch upon entry into Phase 1c,” Maddox said in the press release.

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