The American College of Cardiology (ACC) says those with advanced cardiovascular disease should be prioritized over those with well-managed CVD when it comes to getting the Covid-19 vaccine.

In a position statement released earlier this month, ACC notes that guidelines from the Centers for Disease Control and Prevention recommend those 64 and younger get the vaccine in Phase 1c if they have certain medical conditions, included CVD-related ones, but it didn’t distinguish by severity.

“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,” the ACC said in a press release accompanying its statement.

Weighing controlled vs less controlled

The ACC proposed patients with “poorly controlled hypertension, insulin-dependent diabetes or diabetes with microvascular and/or macrovascular complications as a result of poor glycemic control” be considered higher risk, as should patients with morbid obesity compared to patients who are overweight.

The ACC statement also takes other circumstances into account.

“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,” 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. “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.”

The ACC stressed, however, that its guidance for clinicians is not meant to make those with lower risk believe that they should put off getting the vaccine.