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Covid-19 HSE Clinical Guidance and Evidence

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About - HSE Repository for Interim Clinical Guidance intended for the Clinical Community

This site provides a national easily-accessible repository of clinical guidance to equip the clinical community in Ireland with the requisite information whilst working within the current COVID-19 environment. 

The site contains and enables access to:

  • HSE Interim Clinical Guidance to provide nationally consistent advice to the clinical community in response to the COVID-19 national health emergency, and as core services resume is inclusive of guidance for the provision of both COVID-19 care and non COVID care in a COVID environment.  Guidance is based on best available knowledge at the time of completion, written by clinical subject matter experts (SMEs) working with the HSE.  These SMEs have both expertise and experience of treating patients for the specific health conditions covered by the guidance.
  • Summaries of Evidence prepared by the HSE National Library Evidence team and other stakeholders (these are statements of emerging evidence and do not replace clinical judgement or guidance)
  • An online facility to request additional published COVID-19 evidence in relation to specific clinical questions

Interim Clinical Guidance published on this site is under the governance of CCO CAG.  This guidance takes into consideration advice provided by NPHET relating to the current COVID-19 health emergency. 

The content of the site is not meant to replace clinical judgment or specialist consultation, but rather strengthen clinical management of patients and provide up-to-date and relevant guidance.  The guidance is iterative in nature and is subject to ongoing review to ensure alignment with emerging evidence and updates to national guidelines.  This guidance must be read in conjunction with the National HSE Infection Prevention and Control (IPC) Guidance for Possible or Confirmed COVID-19 

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Latest - Summaries of Evidence

Updated page:18/09/20
What is the evidence on additional risk for people >65 with cardiovascular disease? (Published Sept 17th 2020)

COVID-19 is an infectious disease caused by SARS-CoV-2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission.

COVID‐19 may preferentially infect individuals with cardiovascular conditions; is more severe in subjects with cardiovascular comorbidities; may directly or indirectly affect the heart; and may interact with cardiovascular medications. In addition, the widespread effects of the pandemic on the global healthcare system affects the routine and emergency cardiac care for patients who are, may be or are not infected with COVID‐19.

Potential mechanisms of cardiovascular injury have been identified and include direct myocardial injury from hemodynamic derangement or hypoxemia, inflammatory myocarditis, stress cardiomyopathy, microvascular dysfunction or thrombosis due to hypercoagulability, or systemic inflammation [cytokine storm], which may also destabilize coronary artery plaques. Pneumonia and influenza infections have been associated with six-fold increased risk of acute myocardial infarction (MI).

Until more data with larger numbers of patients are available, it seems reasonable to consider all patients with history of CVD, hypertension or diabetes at higher risk. The risk may be highest for patients with these risk factors, older age, known history of heart failure or clinically significant valvular disease

During the period of the pandemic, older people living with frailty and long-term conditions will continue to experience episodes of ill-health, falls or other unforeseen events, and health professionals will need to continue to respond to provide high-quality, person-centred care. During national emergencies and pandemics, health care services and supply chains may be disrupted. Health care resources may be limited and a focus on controlling a pandemic will deflect focus from other areas. These may include routine care of those with LTCs such as asthma, diabetes and hypertension.


LITERATURE REVIEWS CARRIED OUT FOR THE HEALTH SERVICE EXECUTIVE NATIONAL TELEHEALTH STEERING GROUP April – July 2020 (Published Aug 13th 2020)

Produced by the members of the National Health Library and Knowledge Service Evidence Team. These literature reviews collate the best available evidence at the time of writing and do not replace clinical judgement or guidance. Emerging literature or subsequent developments in respect of technologies may require amendment to the information or sources listed in the document. Although all reasonable care has been taken in the compilation of content, the National Health Library and Knowledge Service Evidence Team makes no representations or warranties expressed or implied as to the accuracy or suitability of the information or sources listed in this document. These literature reviews are the property of the National Health Library and Knowledge Service and subsequent re-use or distribution in whole or in part should include acknowledgement of the service.

Foreword

This collection of literature reviews was created between April and July 2020 by members of the National Health Library and Knowledge Service Evidence Team to support the Health Service Executive National Telehealth Steering Group. Each literature review relates to innovations in telemedicine as applicable to a specific condition or specialty and each is presented as a separate chapter. Additional studies relating to specific conditions or specialities may be added by the Evidence Team as individual chapters are revised and updated. Additional chapters relating to additional conditions or specialities may be added by the Evidence Team.

Using combinations of the subject headings and keywords set out in Appendix 1, the databases CINAHL, EMBASE and Medline were searched and search results filtered for studies published between 2015 and 2020, in English, relating primarily to adult populations and with an emphasis on systematic reviews and randomised controlled trials. Each chapter presents the evidence as illustrated below. Within each section, studies are arranged in reverse chronological order by year and, within a year, in alphabetical order by author surname. Please see Appendix 2 for an alphabetical list of sources referenced per condition or specialty. Please see Appendix 3 for an alphabetical list of all sources referenced.

Definitions: According to the OED, ‘telehealth’ is defined as the provision of health-care services remotely by means of telecommunications technology; the term was first recorded in 1975. ‘Telemedicine’ is defined as medicine practised with the assistance of telecommunications technology, often to provide care in remote locations or to reduce the need for hospital visits; the term was first recorded in 1968. ‘Mobile health’ is defined as health and medical services provided and accessed primarily using smartphones and mobile devices; the term was first recorded as such in 2000.

National Health Library & Knowledge Service. Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hselibrary@hse.ie

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