Are we high risk?

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carolinemc

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I think it all depends upon what your specific problem is. From what I've read if you had an AVR with no comorbidities you are most likely not at enhanced risk. You might be interested in this article posted today: 'Stay on Angiotensin Drugs' Still the Message as Trials Begin
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Any cardiac patient, whether you have surgery or not, is high risk. Ask your cardiac doctor and he/she will explain to you the risks cardiac and other conditions are considered high risk.
 

Protimenow

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I consider my wife and me to be high risk - especially after my two weeks in the hospital. She doesn't even want me to go outside (a bit extreme, but understandable). I have a good mask, bought a box of gloves a few months before the pandemic, and hope to have some help getting groceries.

I have paper towels (a friend who moved out of his house let me have them), enough toilet paper, cans of tuna from my friend's house, and not too much else. We have a younger, healthier friend who will probably pick stuff up for us.

Although I'd like to support restaurants by having food delivered - the food was not in our budget, and the delivery fees tip the scales even further against us.

Oh, well. We'll survive. I hope that all of you who are prisoners in your own homes are doing well.
 

Seaton

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I got a text from the National Health Service here in the UK the other day telling me I was considered high risk and that I should stay home for 12 weeks (minimum, I assume):

NHS Coronavirus Service: Your condition means you are at high risk of severe illness if you catch Coronavirus. Please remain at home for 12 weeks unless a healthcare professional tells you to leave. You will get a letter from the NHS to confirm this.
Support is available for you if you need it to get help with getting food and basic care. Please complete this short form to tell us whether you need this: www.gov.uk/coronavirus-extremely-vulnerable.

I know health vulnerable people in the UK have been receiving these instructions to socially shield for some weeks now. Seems they have finally analysed my notes and considered me high risk.

Whether I’m considered high risk simply because I am post valve replacement (last August) I don’t know.

I had imagined I was without comorbidities, as such, unless they consider my recent January hospital stay with pericarditis to be a potential vulnerability.

I‘ve also had sarcoidosis of the mediastinal lymph nodes in the past (2000-2002), but have thankfully been in remission from that ever since. Perhaps they consider that to be a comorbidity.

Either way, I’ve been instructed to stay put for three months.
 

tom in MO

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I got a text from the National Health Service here in the UK the other day telling me I was considered high risk and that I should stay home for 12 weeks (minimum, I assume):

NHS Coronavirus Service: Your condition means you are at high risk of severe illness if you catch Coronavirus. Please remain at home for 12 weeks unless a healthcare professional tells you to leave. You will get a letter from the NHS to confirm this.
Support is available for you if you need it to get help with getting food and basic care. Please complete this short form to tell us whether you need this: www.gov.uk/coronavirus-extremely-vulnerable.

I know health vulnerable people in the UK have been receiving these instructions to socially shield for some weeks now. Seems they have finally analysed my notes and considered me high risk.

Whether I’m considered high risk simply because I am post valve replacement (last August) I don’t know.

I had imagined I was without comorbidities, as such, unless they consider my recent January hospital stay with pericarditis to be a potential vulnerability.

I‘ve also had sarcoidosis of the mediastinal lymph nodes in the past (2000-2002), but have thankfully been in remission from that ever since. Perhaps they consider that to be a comorbidity.

Either way, I’ve been instructed to stay put for three months.
Better safe than sorry unless you don't believe it. Personally I cannot wrap my head around the fact that someone at 64 is not high risk and someone at 66 is high risk. In my family, I am 62, wife is 66 and has a immune system suppression due to medication. I'm the "tip of the spear" still going to work and shopping once a week. If I was in your place, I'd want to know why I was more vulnerable, just because it would help me comply.

With a mechanical valve, I am at extra risk for endocarditis (e.g. have to premedicate for tooth cleaning). When I got a good infected dog bite, they had me do pills, injections and come in every three days until the infection subsided. However with your tissue valve, you do not have that risk.

Good luck, can you still work from home?
 

Pete81

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Better safe than sorry unless you don't believe it. Personally I cannot wrap my head around the fact that someone at 64 is not high risk and someone at 66 is high risk. In my family, I am 62, wife is 66 and has a immune system suppression due to medication. I'm the "tip of the spear" still going to work and shopping once a week. If I was in your place, I'd want to know why I was more vulnerable, just because it would help me comply.

With a mechanical valve, I am at extra risk for endocarditis (e.g. have to premedicate for tooth cleaning). When I got a good infected dog bite, they had me do pills, injections and come in every three days until the infection subsided. However with your tissue valve, you do not have that risk.

Good luck, can you still work from home?
I don’t think it matters what type of valve you have, mechanical or tissue, with respect to the risk of endocarditis. Risk is higher for both, it is just that the tissue valves usually get infected on the leaflets whereas with mechanical it is usually the sutures. However, could be that with this new inspiris resilia from Edwards that’s different, have you read/heard anything about that?
 

Protimenow

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Risk assessments don't always relate to age. I've heard from one or more sources that 60+ is the age to consider to be risky. A lot of it depends on your physical condition, strength, and other factors - having a valve - mechanical or tissue - will probably make it more difficult to survive the virus -- unless your body is able to fight it. But the ability to 'fight' probably declines as we get older, or if we have other areas of weakness.

It's unclear whether some people are predisposed to more easily deal with the virus than others. at this point, if I had an implanted heart valve, I'd probably act as if my vulnerability was higher than it would be without an implanted valve, and regardless of age.
 

Astro

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The studies that I have seen that look at risk factors for death from Covid 19 are from Wuhan China. They lump cardiovascular disease all together. I think that this mostly means coronary heart disease rather than valvular disease. Has anyone seen an article that separates types of heart disease?
 

rich01

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The studies that I have seen that look at risk factors for death from Covid 19 are from Wuhan China. They lump cardiovascular disease all together. I think that this mostly means coronary heart disease rather than valvular disease. Has anyone seen an article that separates types of heart disease?
My guess is that it is chronic inflammation, in addition to a compromised immune system, that is the problem. It appears that in some people, covid-19 results in massive inflammation. Add that to an already diseased body with chronic inflammation and it's likely more than a compromised immune system can handle. All the comorbidities they mention are chronic inflammatory diseases.
 

Seaton

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Better safe than sorry unless you don't believe it. Personally I cannot wrap my head around the fact that someone at 64 is not high risk and someone at 66 is high risk. In my family, I am 62, wife is 66 and has a immune system suppression due to medication. I'm the "tip of the spear" still going to work and shopping once a week. If I was in your place, I'd want to know why I was more vulnerable, just because it would help me comply.

With a mechanical valve, I am at extra risk for endocarditis (e.g. have to premedicate for tooth cleaning). When I got a good infected dog bite, they had me do pills, injections and come in every three days until the infection subsided. However with your tissue valve, you do not have that risk.

Good luck, can you still work from home?
Greetings Tom

... can you still work from home?

I can do bits and pieces from home but nothing ‘substantial’. Seems pottering is the new normal – which suits me fine! 😎

Got another NHS text today:

If you believe you have been contacted in error you can check the list of identified conditions.
If you are confident that this does not apply then you can opt out of receiving these messages and contact your GP to be removed from the list of highest risk patients.

The NHS list of identified conditions [see link above], doesn’t seem to relate to post AVR patients in and of itself. It seems my GP is suggesting I am vulnerable perhaps because I have had potential comorbidities in the past, including an infection of the pericardium in January this year. They are maybe erring on the side of caution.

Got this text today, too:

NHS Coronavirus Service: Do you live with others? To stay safe from the virus please try to:
- Stay 3 steps away from others
- Sleep separately if you can
- Use separate bathrooms if you can. If you share, use it first and clean between uses
- Eat separately, use separate cutlery, dishcloths, towels
- Clean and wipe down door handles and surfaces in the kitchen and bathroom before use
Only essential carers should visit. Ask people to leave your supplies at your door.


If I was in your place, I'd want to know why I was more vulnerable, just because it would help me comply.

I may give my GP a call Monday to discuss their reasoning for wanting me to shield. But even without the imposition of the restrictions they are suggesting, rather than take any risks I have been practising pretty stringent self-isolation anyway.

Personally I cannot wrap my head around the fact that someone at 64 is not high risk and someone at 66 is high risk. In my family, I am 62, wife is 66 and has a immune system suppression due to medication. I'm the "tip of the spear" still going to work and shopping once a week.

There is a list in The Guardian here today of a variety of people who have succumbed to the virus. It makes for sobering reading and shows that all ages and all sorts of health variables are affected:

‘So much living to do’: stories of UK's coronavirus victims

Very best of health to your wife and yourself, Tom.
 
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Paleowoman

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I may give my GP a call Monday to discuss their reasoning for wanting me to shield.
Hi Seaton,

The government’s list of extremely vulnerable people who should shield includes only those with cancer being treated with chemotherapy, people on immunotherapy, people with severe asthma, severe COPD, cystic fibrosis, bone marrow transplants within the last six months, people with rare diseases and inborn errors of metabolism that increase risk of infection, and pregnant women who also have severe heart disease.

You could contact your GP to check why you are on that list. My GP was shocked at the restricted list, and said regardless I should self isolate for 12 weeks (at least) due to my heart problem and respiratory problem - but I am not on that list because those specific problems aren't on the list and the GP cannot put me on it...unless that's changed since she spoke to me, maybe your GP was able to put you on the list if he/she had thought it necessary due to perhaps your pericardium infection earlier this year ?

I’ve been nearly four weeks in self isolation now and am finding it fine apart from the stress of getting shopping. DH isn’t allowed to go shopping or GP fears he’d bring virus back to me if he caught it. We have got a shopping service via social services but it is not ideal (very nice lady but makes loads of mistakes !), and it is nearly impossible to get an online delivery slot - if I were on that government list online shopping would be easier as the supermarkets are inviting those on the list to take delivery slots !

All the very best....and stay safe !
 

Paleowoman

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Hi @Seaton

Article just popped up in the Guardian which might explain your letter UK government 'giving incorrect information on self-isolation', say GPs:

People across the UK are being given incorrect information from the government about whether or not to isolate, with some wrongly instructed to remain indoors for 12 weeks, GPs have warned.

Doctors fear out-of-date information is being used as they are getting an increasing number of calls from people who do not understand why they have received a text or letter saying they are in the most at risk group. At the same time, some of those who are in priority groups are complaining they have been given no information, they said.


 

Seaton

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Thanks for the pointer @Paleowoman! Seems there’s some real confusion going on.

I will contact my GP to discuss and maybe my lead cardiac nurse at St Thomas‘ too, if possible, and see what the consensus is. I wonder if you’ll get a letter this coming week?
 

Stowegirl

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Ive not been following this thread so far as the whole thing leaves me in fear. I guess Im going to have to make some kind of contact with my hospital and surgeon because I have no idea what is going on. No new symptoms though when Im sure I will be in touch.
With regard to the NHS letters etc, Im not regarded as very high risk and don't come under the list which includes cancer sufferers etc However I do act near enough as if I am because I believe it would not do me any good to get this virus.
But so far as whether they have the right people on a list to be warned, I think theyve missed out my Parents for example who, while they are reasonably healthy, are both 90 and surely cannot be expected to fend for themselves, get their own shopping, stand in queues and not it literate enough to organise the online shopping that is a nightmare if you dont know what youre doing.
Or maybe they don't care about 90 year olds if we go by the herd immunity theory that is mentioned.
 

tom in MO

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Greetings Tom


I can do bits and pieces from home but nothing ‘substantial’. Seems pottering is the new normal – which suits me fine! 😎

Got another NHS text today:

If you believe you have been contacted in error you can check the list of identified conditions.
If you are confident that this does not apply then you can opt out of receiving these messages and contact your GP to be removed from the list of highest risk patients.

The NHS list of identified conditions [see link above], doesn’t seem to relate to post AVR patients in and of itself. It seems my GP is suggesting I am vulnerable perhaps because I have had potential comorbidities in the past, including an infection of the pericardium in January this year. They are maybe erring on the side of caution.

Got this text today, too:

NHS Coronavirus Service: Do you live with others? To stay safe from the virus please try to:
- Stay 3 steps away from others
- Sleep separately if you can
- Use separate bathrooms if you can. If you share, use it first and clean between uses
- Eat separately, use separate cutlery, dishcloths, towels
- Clean and wipe down door handles and surfaces in the kitchen and bathroom before use
Only essential carers should visit. Ask people to leave your supplies at your door.



I may give my GP a call Monday to discuss their reasoning for wanting me to shield. But even without the imposition of the restrictions they are suggesting, rather than take any risks I have been practising pretty stringent self-isolation anyway.


There is a list in The Guardian here today of a variety of people who have succumbed to the virus. It makes for sobering reading and shows that all ages and all sorts of health variables are affected:

‘So much living to do’: stories of UK's coronavirus victims

Very best of health to your wife and yourself, Tom.
Hi Seaton,

Thanks for the extra info. It's always nice to err on the side of caution, but 12 weeks isolated is not really insignificant. Sometimes "pottering around" requires supplies to potter :) I noted your "About" says you are an artist, hopefully not doing large canvases, but you can always paint over them :) My daughter is also an artist, but not by occupation. Her studio is in our house and she's not coming around due to my wife's compromised immune system. She's been "jonesing" for some pottering.

Best of health to you and yours as well.
Tom
 
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rich01

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From summary of Preventing Cardiac Complication of COVID-19 Disease With Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial. (C-19-ACS).
ClinicalTrials.gov Identifier: NCT04333407.
At present, and despite pressing need for therapeutic intervention, management of patients with COVID-19 is entirely supportive. Despite the majority of patients experiencing a mild respiratory illness a subgroup, and in particular those with pre-existing cardiovascular disease, will experience severe illness that requires invasive cardiorespiratory support in the intensive care unit.

Furthermore, the severity of COVID-19 disease (as well as the likelihood of progressing to severe disease) appears to be in part driven by direct injury to the cardiovascular system. Analysis of data from two recent studies confirms a significantly higher likelihood of acute cardiac injury in patients who have to be admitted to intensive care for the management of COVID-19 disease.

The exact type of acute of cardiac injury that COVID-19 patients suffer remains unclear. There is however mounting evidence that heart attack like events are responsible. Tests ordinarily performed to definitely assess for heart attacks will not be possible in very sick COVID-19 patients. Randomising patients to cardioprotective medicines will help us understand the role of the cardiovascular system in COVID-19 disease. It will also help us determine if there is more we can do to treat these patients.
 

Astro

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From summary of Preventing Cardiac Complication of COVID-19 Disease With Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial. (C-19-ACS).
ClinicalTrials.gov Identifier: NCT04333407.
That study will be interesting. Hopefully it has some results early enough to help with this outbreak. There is a thought that anticoagulation might be beneficial in serious COVID infection to try to prevent microemboli (small clots in small blood vessels of important organs such as heart and kidneys). This makes me feel a little better about taking warfarin.
 

pellicle

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This makes me feel a little better about taking warfarin.
it seems to me that when one is younger its natural to wish to avoid drugs. However as we age its better to accept that some drugs actually do help us live longer. One of my mates (the pharmacist) started taking baby aspirin after he turned 40 because of the evidence from the literature. Clots causing strokes happen in the general population as we age, by being on warfarin early and by being a good ACT dosage manager you stand the best chance of never having a stroke and avoiding the bleed complications associated with warfarin (because of decades of inadequate management practices). That and regular exersize, healthy eating and a moderate alcohol intake will give you the best chances of a long and healthy life
 

LondonAndy

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... But so far as whether they have the right people on a list to be warned, I think theyve missed out my Parents for example who, while they are reasonably healthy, are both 90 and surely cannot be expected to fend for themselves, get their own shopping, stand in queues and not it literate enough to organise the online shopping that is a nightmare if you dont know what youre doing.
Or maybe they don't care about 90 year olds if we go by the herd immunity theory that is mentioned.
The government's letter was specifically to people with certain medical conditions that make them particularly vulnerable, not based on age. However, of course there was also the letter and leaflet sent to every household which gave guidance for those over 70 years old, summarised on the gov.uk/coronavirus website if you didn't get it for some reason.
 

Alisbaba

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Hi,

I had a letter today from the NHS just saying I’m at higher risk of getting I’ll and and being hospitalised and that I should follow the governments guidelines. I have mild asthma and bicuspid valve. It doesn’t say to shield for 12 weeks.

Here is a good link that says who’s at risk.

 
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