Consensus guidelines for interventional cardiology services delivery during COVID-19 pandemic in Australia and New Zealand

The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals 1. Efficient use of resources (including staff, personal protective equipment [PPE]) 2. Direct interventional cardiology use towards the highest yield use of hospital capacity 3. Minimise adverse patient outcomes 4. Minimise risk to healthcare workers. Considerations 1. Fibrinolysis may be considered (or even preferred) in ST segment elevation myocardial infarction (STEMI) reperfusion in hospitals even with catheter laboratories 2. Postponement of non-urgent procedures to reduce demand on beds, use of PPE, staff and other resources 3. Postpone invasive angiography in “stable” ischaemic heart disease patients 4. Postpone non-urgent transcatheter aortic valve implantation (TAVI) and Mitra-clip^TM and all atrial septal defect (ASD)/patent foramen ovale (PFO) and left atrial appendage (LAA) closure procedures 5. In health care networks, centralisation of primary angioplasty services may be possible 6. Training of staff in proper PPE donning and doffing is mandatory 7. Fragmentation of staff into teams is desirable and can mitigate risk of exposure and impact on staffing levels to a degree 8. Working closely with ED, ICU and anaesthetics services from planning to processes promotes efficiency and reduces stress in practice.