ACC Health Policy Statement on Cardiovascular Disease Considerations for COVID-19 Vaccine Prioritization.

2021 
The coronavirus disease 2019 (COVID-19) has had a devastating impact on healthcare systems around the world, with nearly 99 million cases and 2.1 million associated deaths as of January 2021 (1). As such, the rapid development and availability of multiple vaccines are welcome in the long and arduous fight against COVID-19. 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. There are numerous factors that influence the risk for adverse outcomes in COVID-19, including the exposure risk for contracting COVID-19 and the clinical risk for adverse health outcomes with infection. The phased rollout of the vaccines by the Centers for Disease Control and Prevention (CDC) mirrors this framework by prioritizing older age groups and patients with significant medical comorbidities (2). The guidance specifies that during the Phase 1c allocation, all patients from 16 to 64 years of age with medical conditions that increase the risk for severe COVID-19 infection should receive the vaccine. Although the guidance specifies that heart conditions, hypertension, diabetes, obesity, and smoking are examples of such high-risk medical conditions, further delineation of varying levels of risk among patients with cardiovascular disease (CVD) is absent. As the largest professional society of cardiovascular (CV) professionals in the United States, the ACC aims to offer specific guidance about how CV conditions contribute to the risk for adverse outcomes with COVID-19 infection to inform its membership and the patients they serve. In this policy document, we: 1) outline the overall considerations of both exposure and clinical risk needed for vaccine allocation efforts; 2) present the specific evidence and risk considerations related to CVD and COVID-19; and 3) propose a schema of CV risk to incorporate into vaccine allocation decisions.
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