IJCS | Volume 33, Nº4, July and August 2020

417 Pandemic and Delayed Care for Patients with Decompensated HF The evidence that the hospital can be a place where the infection can be contracted has dramatically reduced the access of non-COVID-19 patients to emergency care and emergency services, as well as elective hospital activities not related to COVID-19. The need to reorganize hospital activities to treat patients who suffer from severe forms of COVID-19 requires us to learn the safe treatment of patients who stay at home with milder forms of COVID-19, and the need to keep more vulnerable individuals, such as those with HFpEF, out of hospital. The flexible use of tools such as telemedicine, for integration and not as an alternative to traditional care, adapted to the needs of clinical, family and social health contexts, could allow the creation of personalized, effective, and efficient management programs for the care of these patients, 46 as recommended in the II Brazilian Directive on Telemedicine in Cardiology of the Brazilian Society of Cardiology. 47 Final considerations HFpEF is multifactorial and has a pathophysiological relationship with multiple comorbidities such as hypertension, diabetes, obesity, atrial fibrillation, advanced age, and atherosclerosis. The systemic inflammatory state is a common link between these elements. COVID-19 has a well-defined etiological agent; however, its morbidity and lethality vary with the host. The intense systemic inflammatory response also seems to be the link that explains the worsening of the clinical condition. Comorbidities have emerged as predictors of poor prognosis in SARS-CoV2 infection since the beginning of its description, and in both HFpEF and COVID-19, they constitute the pernicious and disastrous element. If they are in pairs - HFpEF and COVID-19 - maximum alert, double care. Author contributions Conception and design of the research: Mesquita ET; Jorge AJL; Villacorta Junior H; Danzmann LC; Martins WA. Writing of the manuscript Mesquita ET; Jorge AJL; Villacorta Junior H; Danzmann LC; Martins WA. Critical revision of the manuscript for intellectual content : Mesquita ET; Jorge AJL; Villacorta Junior H; Danzmann LC; Martins WA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020 May;109:102433 2. Gorbalenya AE, Baker SC, Baric RS, Groot RJ, Drosten C, Gulyaeva AA, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group. bioRxiv 2020. [Cited in 2020 Apr 04] Availaable from: https://www.biorxiv.org/ content/10.1101/2020.02.07.937862v1.full.pdf. Acesso em 12/04/2020. 3. BRASIL. Ministério da Saúde. Painel Coronavírus. [Acesso em 2020 abr 04]. Disponível em https://covid.saude.gov.br/. 4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Feb 7;323(11):3061-9. 5. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514 – 23. 6. Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons evaluated for 2019 novel coronavirus - United States, January 2020. MMWR Morb Mortal Wkly Rep. 2020;69(6):166-70. 7. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497- 506. Epub 2020 Jan 24. 8. ChenN, ZhouM, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. 9. Yang X, Yu Y, Xu J, ShuH, Xia J, LiuH, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia inWuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 Feb 24. pii: S2213-2600(20)30079-5. 10. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus infected pneumonia. N Engl J Med. 2020;382(13):1199-207. References Mesquita et al. HFpEF and COVID-19 Int J Cardiovasc Sci. 2020; 33(4):412-418 Viewpoint