Reassurance on ACE inhibitors, ARBs and COVID-19; new rules, advice from CMS and CDC

Medical organizations and government agencies continued to update their guidance on COVID-19, and ACP offered related new resources for physicians.

On March 17, cardiology experts issued a joint statement recommending that patients not discontinue angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers due to concern about the risk of more severe infection. The evidence does not indicate any increase in adverse outcomes from COVID-19 associated with these drugs, according to the statement from the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology. Concerns about these drugs, as well as ibuprofen, had been raised by a research letter published by The Lancet Respiratory Medicine on March 11. The authors of the letter subsequently issued a statement clarifying that their hypothesis was intended to spur further research, not changes in treatment. On March 19, the FDA also issued a response to the research letter, saying that the agency is not aware of scientific evidence connecting the use of NSAIDs with worsening COVID-19 symptoms but is investigating the issue further.

On March 18, CMS called for all elective surgeries and all nonessential medical, surgical, and dental procedures to be postponed and issued several waivers, mostly related to hospital care. A full list of CMS actions in response to the emergency is on the agency's website. ACP released letters on the federal stimulus package over the weekend and continues to press the U.S. government to do more to address COVID-19.

The CDC issued new advice on when to discontinue isolation for patients recovering from COVID-19 at home and updated its recommendations for optimizing the supply of personal protective equipment. All of the agency's guidance on COVID-19 is collected on a page for health care professionals. The FDA has also offered strategies for dealing with shortages of medical gloves and ventilators.

ACP launched a new interactive CME program about telemedicine and scheduled a webinar on physician well-being during the COVID-19 pandemic. The College also offers resources for helping patients identify their health outcome goals, and Annals of Internal Medicine has recently published several research articles about COVID-19.

“Telemedicine: A Practical Guide to Incorporation into Your Practice,” is free to ACP members and provides guidance about how to introduce and sustain a telemedicine program and deliver high-quality health care. It includes details about the necessary technical, licensure, insurance, and reimbursement components as well as success stories and timely information about patient care during pandemics and public health crises. It was developed with support from an unrestricted educational grant from Amwell. It's one of a number of new resources on telehealth from ACP.

The upcoming webinar will offer practical advice and support from internists on the front lines of the pandemic. Eileen Barrett, MD, MPH, FACP, and Elisabeth Poorman, MD, will share lessons learned and best practices for both outpatient and inpatient internists on Monday, March 30, at 3 p.m. EDT. They will explore the need to acknowledge and address physician anxiety and fear of exposure to the virus, as well as provide tips for how physicians can support one another during this crisis while protecting their own well-being. Dr. Barrett is a member of ACP's Board of Regents and an ACP Well-being Champion. Dr. Poorman is an internist who also researches medical workplace safety, mental illness in medicine, and physician suicide. Participants will have the opportunity to ask questions, and a discussion will continue following the webinar in ACP's COVID-19 Member Forum. This free webinar is presented jointly by the ACP Leadership Academy and the ACP Well-being and Professional Fulfillment program.

ACP is supporting the Infectious Diseases Society of America (IDSA)'s weekly podcast series to keep members informed regarding the COVID-19 situation. On March 17, the IDSA issued new recommendations on prioritization of testing for the virus given the limited availability of tests. ACP's COVID-19 resources for internists, including educational activities, are available on a regularly updated webpage.