ACC urges COVID-19 vaccine prioritization for highest risk heart disease patients

February 12, 2021

COVID-19 vaccine prioritization should prioritize those with advanced cardiovascular (CVD) disease over well-managed CVD disease, according to an American College of Cardiology (ACC) health policy statement published in the Journal of the American College of Cardiology (JACC). All CVD patients face a higher risk of COVID-19 complications and should receive the vaccine quickly, but recommendations in this paper serve to guide clinicians in prioritizing their most vulnerable patients within the larger CVD group, while considering disparities in COVID-19 outcomes among different racial/ethnic groups and socioeconomic levels.

"A coherent vaccine allocation strategy will consider the exposure risks and clinical risks of given individuals and populations," said Thomas M. Maddox, MD MSc, professor of cardiology at Washington University School of Medicine in St. Louis and co-chair of the health policy statement. "In addition, it will take into account those demographic populations that, for a variety of reasons, have additional risks that lead to higher rates of COVID-19 infection and severe health outcomes."

As of January 2021, there were almost 99 million COVID-19 cases and over 2 million deaths caused by the coronavirus worldwide. With the quick development of multiple vaccines, the Centers for Disease Control and Prevention (CDC) issued phased recommendations for which populations should get vaccinated first. Under Phase 1c of the CDC guidance, all patients from 16-64 years old with medical conditions that increase the risk for severe COVID-19 infection should receive the vaccine. Although the guidance states that heart conditions, hypertension, diabetes, obesity and smoking are examples of such high-risk medical conditions, it was silent on varying levels of risk among the variety of CVD conditions that cardiovascular clinicians manage.

In response, the writing group developed a policy statement that provides overall considerations of both exposure and clinical risk needed for vaccine allocation efforts. It presents the specific evidence and risk considerations related to CVD and COVID-19, and proposes a tiered schema of CVD risk to incorporate into vaccine allocation decisions. In addition, this policy statement highlights the large disparities in COVID-19 and CVD outcomes among racial and ethnic groups and different socioeconomic status levels and calls for consideration of these disparities in allocation decisions.

"Our proposed vaccine allocation schema outlines key CVD clinical risk considerations within the broader context of key overall risk considerations including exposure, disparities, health care access, advanced age and multimorbidity," Maddox said. "Patients' risk categorization is determined by highest tier in which meet one or more of its criteria."

Some examples in the proposed vaccine allocation schema include patients with poorly controlled hypertension, insulin-dependent diabetes or diabetes with microvascular and/or macrovascular complications as a result of poor glycemic control should be considered higher risk compared to patients who are medically optimized. Similarly, patients with morbid obesity should be considered higher risk compared to patients who are overweight.

Patients with severe medical conditions, such as advanced CVD, may require long-term stays in nursing homes or rehabilitation centers, which increases their risk of COVID-19 exposure. Data shows that the clinical risk for severe COVID-19 infection is associated with both advanced age and preexisting medical conditions, especially when two or more co-occur. In addition to multimorbidity, data has found adverse effects of frailty in patients with COVID-19. The CDC's phased vaccine allocation recommendations prioritize patients with advanced age, which is in accordance with the CVD-related risk associated with advanced age. However, this policy statement urges older patients with multiple comorbidities, including CVD conditions and/or frailty should be prioritized for COVID-19 vaccination.

"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," Maddox said.
-end-
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit
The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals--JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology, JACC: Basic to Translational Science, JACC: Case Reports, JACC: CardioOncology and JACC: Asia--that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at

American College of Cardiology

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.