The following are key points to remember from this consensus report about the safe reintroduction of cardiovascular (CV) services during the coronavirus disease 2019 (COVID-19) pandemic:

1. COVID-19 has resulted in reductions in routine medical care in an effort to reduce its spread and preserve limited resources. However, patients with untreated or undiagnosed CV disease are also at risk of adverse events. This document provides guidance on the safe reintroduction of CV procedures and testing following the initial peak of COVID-19.
2. Reintroduction of services must be based on an ethical strategy to maximize the benefits to patients, provide fairness to address health care inequities, weigh the benefit of procedures against the risk of spreading the virus, and be consistently applied regardless of ethnicity and social differences.
3. Hospital CV teams must partner with regional public health officials to monitor regional patterns of COVID-19 and work together on plans to reintroduce CV services, as well as plans to stop elective services if COVID-19 cases increase. A cohesive partnership is needed to respond to fluctuations in virus-related hospitalizations and deaths.
4. The protection of patients and health care workers needs to be addressed before reintroduction of CV services, and there must be adequate critical care capacity, personal protective equipment (PPE), trained staff, adequate COVID-19 testing capacity, and preparation for increased COVID-19 testing if needed.
5. To protect patients and health care workers, there must be strategies to provide physical distancing and limit patient contact, including incorporation of virtual care and minimizing visitors with patients. Routine COVID-19 screening prior to procedures may be considered, and health care workers should use appropriate PPE.
6. A table is provided to harmonize the recommendations of major North American CV societies for specific CV services across three Response Levels to be assigned in collaboration with regional public health officials. Level 2 plans for reintroduction of some services, Level 1 plans for reintroduction of most services, and Level 0 plans for regular services with ongoing testing and surveillance of COVID-19. These levels are expected to dynamically change depending on regional conditions and in collaboration with ongoing regional health officials.
7. Level 2 (reintroduction of some services) proposes resuming CV services in high-risk patients, such as coronary interventions for high-risk individuals (e.g., ST-elevation myocardial infarction), valve surgery or interventions in high-risk patients (e.g., symptomatic severe aortic stenosis), electrophysiology procedures in high-risk patients (e.g., pacemakers for high-risk patients), echocardiography in patients where findings will impact short-term management, and other imaging (computed tomography, magnetic resonance, and nuclear imaging) for inpatients and selected outpatients. For stress testing, pharmacologic testing is preferred over exercise testing.
8. Level 1 (reintroduction of most services) resumes most CV services with the option for deferral of services for stable patients. For example, stable patients planned for echocardiography or ablation procedures could be deferred.
9. Level 0 (regular services with ongoing surveillance of COVID-19) provides for routine CV services for all patients.
10. This consensus report provides a dynamic approach to reintroductions of CV services in alignment with local public health officials and regional COVID-19 conditions.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiovascular Care Team, COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and ACS, Interventions and Imaging, Interventions and Structural Heart Disease, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Cardiovascular Surgical Procedures, Catheter Ablation, Coronavirus, COVID-19, Critical Care, Diagnostic Imaging, Diagnostic Tests, Routine, Echocardiography, Electrophysiology, Exercise Test, Heart Valve Diseases, Magnetic Resonance Imaging, Percutaneous Coronary Intervention, Personal Protective Equipment, Primary Prevention, Public Health, severe acute respiratory syndrome coronavirus 2, Psychological Distance, Tomography, Emission-Computed

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