COVID Vaccines with Heart Disease

 
Covid and Heart disease your questions answered.jpg

Article written by Dr Ee-May Chia (Cardiologist)

As we are grappling with the increase in cases of the Delta variant of COVID-19, I would like to let you know that myself and the team at Hurstville Heart Centre are here if you have any queries about your patients and their care in this difficult time.

I also wanted to take this opportunity to update you regarding the use of COVID vaccines with heart disease. It has been an extremely common question that we at the Heart Centre have been fielding of late.

We are encouraging all of our patients with heart disease to get vaccinated. The chances of serious sequelae with COVID in those with cardiovascular disease are very high (1-2). Both the Pfizer and Astra-Zeneca vaccines available have no known interactions or interference with their heart condition or medications (3). Emerging data from the current NSW outbreak as well as from overseas indicates that vaccination protects from infection and reduces the severity of the disease (4).

With both vaccines, common adverse effects include headache, nausea, muscle pain, fever and chills. These symptoms are usually not severe and self-limiting.

In Australia as documented by TGA August 2021, there has been 6.3 million Astra Zeneca doses administered. Patients have been extremely scared of the potential complications of TTS (thrombosis and thrombocytopaenia syndrome) due to its close scrutiny in the media. ATAGI’s last update in July has estimated this risk in Australia to be 2.7 per 100 000 for those < 60 years and 1.6 per 100 000 in those >/= to 60 years (5).

The Comirnaty (Pfizer) vaccine in Australia has now been approved for those > 16 years and 12-15 years in selected higher risk groups. TGA has issued a warning for the incidence of myocarditis and pericarditis from the vaccine, although from overseas trials, this is more common in males < 30 years of age and more commonly after the 2nd vaccine dose (6-7). Again, the symptoms are usually transient and resolve with rest, but we do advise seeking medical attention if symptoms do occur. 

So in summary, the current TGA guidelines as of this publication for COVID-19 vaccination is that the Pfizer vaccine is preferred for ages 16-60. However, due to the large current outbreak, the benefits of the AstraZeneca vaccine strongly outweighs the rare vaccine effects in all age groups (8-9). 

We are still working hard through these difficult times, and I am happy to offer both in person and teleconferencing consults where possible. All cardiac testing and reviews are still proceeding for all your patients in need. Most importantly stay safe and I hope to see you all in person soon. 

References

  1. Huang C, Wang Y, Li X et al. Clinical feature of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506

  2. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19). Outbreak in China: Summary of report of 72314 cases from the Chinese Centre for Disease Control and Prevention. JAMA 2020

  3. Health.gov.au/sites/default/files/documents/2021/08/covid-19-vaccination-guidance-on-myocarditis-and-pericarditis-after-mrna-covid-19-vaccines.pdf

  4. Health.nsw.gov.au/infectious/covid-19/Pages/weekly-reports.aspx

  5. Health.nsw.gov.au/news/Atagi-update-following-weekly-covid-19-meeting-21-july-2021

  6. Montgomery J, Ryan M, Engler R et al. Myocarditis following immunization with mRNA COVID-19 vaccines in member of the US military. JAMA Cardiol June 29 2021.

  7. Kim HW, Jenista ER, Wendell DC et al. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA Cardiol 29 June 2021

  8. Tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-05-08-2021

  9. Health.gov.au/news/Atagi-statement-response-to.nsw-covid-19-outbreak-24th-july-2021

 
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