General Guidance on Deferring Non-Urgent CV Testing and Procedures During the COVID-19 Pandemic
Mar 24, 2020
With a primary goal of reducing the risk of infection/spread of COVID-19, protecting our patients and care teams, enhancing capacity to respond to the pandemic, and preserving access to necessary cardiovascular care, many clinics and hospitals have begun deferring non-urgent cardiovascular testing and procedures.
In general, it is reasonable to consider deferring any test or procedure that is unlikely to directly impact clinical care or outcomes over the next several months.
In keeping with the Centers for Disease Control and Prevention's recommendation to reschedule "non-urgent outpatient visits" and "elective surgeries as necessary," an effort has been made to identify tests and procedures that have the potential to be deferred. The following list represents a "starting point" for conversations on this topic.
This list is likely to change over time, depending on hospital capacity and staff availability, particularly in the setting of a COVID-19 surge. Whenever possible, preference should be given to testing that can be done by alternative means or remotely (e.g., interrogation of cardiovascular implantable electronic devices).
Decisions about what tests/procedures to perform (or not perform) should be based on individualized risk assessment, informed by the patient's clinical status. Shared decision-making between patients and members of the care team represents an important component and as such, should be clearly documented in the medical record.
Clinical Service Area
Tests/Procedures with the Potential for Deferral
Cardiovascular Stress Testing and Imaging
Stress testing (ECG alone or with imaging [echocardiography, radionuclide, MRI]) for suspected stable ischemic heart disease (outpatient and inpatient)
Cardiopulmonary exercise testing for functional assessment (outpatient and inpatient)
Transthoracic echocardiograms (outpatient)
Transesophageal echocardiograms in stable patients (outpatient and inpatient)