The CDC’s phased approach to vaccine distribution puts all patients ages 16 to 64 with medical conditions that increase the risk for severe COVID-19 infection in the 1c category, citing heart conditions, hypertension, diabetes, and obesity among examples. However, the CDC made no attempt to stratify by levels of risk among those conditions. “A coherent vaccine allocation policy promoting the greatest benefit for the greatest number would prioritize individuals with the highest risk for adverse outcomes of COVID-19 ahead of lower-risk populations” said Elissa Driggin, MD, of New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York City, and colleagues on the ACC Solution Set Oversight Committee writing group in the Journal of American College of Cardiology.
The goal of the group was to propose a “schema of CV risk to incorporate into vaccine allocation decisions.” “We hope that this document can be used to guide COVID-19 vaccine allocation and patient outreach in the context of prolonged demand-supply mismatch as we enter Phase 1c,” Driggin’s group wrote. The top tier of risk for severe COVID-19 outcomes comprised people with:
- An unplanned cardiovascular disease hospitalization within the prior 6 months
- Class III or IV pulmonary hypertension
- Adult congenital heart disease patients with physiological stage C or D
- High-grade pulmonary arterial disease
- Obstructive coronary artery disease (triple vessel or left main cases, or one- or two-vessel disease with angina)
- Advanced heart failure or heart transplant
- Morbid obesity
- Two or more comorbid, poorly controlled risk factors, such as hypertension and diabetes
- Poorly controlled insulin-dependent diabetes
For heart disease patients, Driggin’s group cautioned that their risk-stratification schema shouldn’t discourage anyone from taking their shot at the vaccine, adding, it “does not suggest that individuals with lower-risk CV conditions should delay or avoid receiving the vaccine.”
Stay the course, stay well, mask up, get vaccinated, and stay tuned!