This poll evaluated the impact of the COVID-19 pandemic on adult heart transplantation programs' management of advanced heart failure patients. The poll garnered results from 47 adult heart transplant clinicians from 12 different countries, with 70.2% being in the United States (US). Most respondents (79.3%) reported the pandemic altered their approach to supporting patients awaiting heart transplant. Over one-fifth (21.7%) reported stopping their transplant program at some point and/or being more selective in accepting potential organ matches (Question 1). Concern in the transplant community remains high that despite the anti-inflammatory effects of post-transplant immune suppression, solid organ transplant recipients are at increased risk for morbidity and mortality with COVID-19 based on evidence that respiratory illnesses are associated with greater disease severity and prolonged viral shedding in this population.¹ COVID-19 related mortality in solid organ transplant patients has been reported at 18%² and in heart transplant recipients at 25%.³

Driven by concerns related to COVID-19, practices changes have been observed. A recent analysis of UNOS/SRTR comparing the COVID-19 era (March 15-May 9, 2020) to the pre-COVID-19 era (January 19-March 15, 2020) found increased waitlist inactivations, decreased waitlist additions, decreased donor recovery, and decreased overall heart transplant volumes. Heart transplant volumes were lower in the COVID-19 era across all regions except the Northwest.⁴

As is common with this complex heterogenous patient population, approaches to the case scenario were highly varied among responding centers with 59.6% reporting they would pursue an inpatient management strategy, while 40.4% report they would aim for outpatient management (Question 2). This split may reflect the complexity of balancing the varied risks and benefits of these approaches, a balance that may vary city by city and week by week. Outpatient monitoring may minimize the risk of healthcare related disease transmission and the use of limited healthcare resources, while inpatient monitoring may decrease potential community exposures and difficulty with close follow up. Due to limitations of the poll, it is unclear if differences in response patterns reflect baseline variation in management of advanced heart failure patients related to center specific or regional practices, or if they reflect the highly varied impact of the pandemic on centers at the time of the survey.

Question 1

Question 2

References

1. DeFilippis EM, Reza N, Donald E, Givertz MM, Lindenfeld J, Jessup M. Considerations for heart failure care during the COVID-19 pandemic. JACC Heart Fail 2020;8:681-91.
2. Pereira MR, Mohan S, Cohen DJ, et al. COVID-19 in solid organ transplant recipients: initial report from the US epicenter. Am J Transplant 2020;20:1800-8.
3. Latif F, Farr MA, Clerkin KJ, et al. Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019. JAMA Cardiol 2020;May 13:[Epub ahead of print].
4. DeFilippis EM, Sinnenberg L, Reza N, et al. Trends in US heart transplant waitlist activity and volume during the coronavirus disease 2019 pandemic. JAMA Cardiol 2020;Jul 22:[Epub ahead of print].

Clinical Topics: Cardiac Surgery, COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant

Keywords: Heart Failure, COVID-19, Pandemics, severe acute respiratory syndrome coronavirus 2, Coronavirus, Coronavirus Infections, Outpatients, Inpatients, Virus Shedding, Follow-Up Studies, Heart Transplantation, Tissue Donors, Monitoring, Ambulatory, Risk Assessment

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