The standard of care is a relatively fluid concept that reacts to evolution in science and medicine. In Washington the standard of care is defined as “the degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class which he or she belongs, in the state of Washington, acting in the same or similar circumstances.” One way of thinking about it is that when science makes advances, medicine responds, and the expectation of what a reasonably prudent provider adjusts accordingly. Similarly, when a new disease appears, a standard of care develops for how to treat the condition. For example, the standard of care continues to evolve in response to the COVID pandemic.
Ultimately juries are arbiters of the standard of care in a medical malpractice dispute – they are presented with different opinions of what it is, and then have to decide who they believe. They get opinions on the standard of care from expert witness testimony; they often testify about patterns and practices, or how guidelines published by illustrious organizations inform providers of the standard of care.
And so it is that the American College of Cardiologists has published guidance for evaluation and treatment of long COVID (Post-acute sequelae of SARC-CoV-2 infection, or “PASC”) with heart symptoms. We are now two years into the COVID pandemic, and enough patients with long COVID have been treated that the ACC has developed these guidelines. Long COVID is a recurring or lingering collection of symptoms related to COVID. The guideline states that patients with long COVID should undergo evaluation including laboratory tests, ECGs, echocardiography, and ambulatory rhythm monitoring (Holter monitor). Abnormal results merit a cardiology consult.
Patients should then be split into two groups – one of outright cardiovascular disease or a wide range of cardiovascular symptoms that cannot be explained by testing, but called “cardiovascular syndrome.” Therapies recommended for patients with PASC cardiovascular syndrome target cardiovascular exercise to counter the downward spiral of COVID patients easily deconditioned from decreased activity.
As more evidence comes out of long term benefits from different therapies these guidelines will no doubt be further refined, and with it the standard of care will adjust accordingly.
