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Tier 1 (0–30% inpatient Covid-19 load, mild reduction in operative capacity)
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All in-patients waiting for surgery, including emergency services
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Asymptomatic outpatients
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Outpatients who are at greatest risk of adverse events
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Truly elective interventions
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Asymptomatic or minimally symptomatic
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Severe mitral regurgitation
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Atrial septal defect and/or patent foramen ovale surgery
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Asymptomatic aneurysm with demonstrated stable size
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Isolated arrhythmia procedures
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Tier 2 (30–60% inpatient Covid-19 load, moderate reduction in operative capacity)
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All in-patients waiting for surgery, including emergency services
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Asymptomatic outpatients and patients with anatomy and physiology suggesting delay can be provided with reasonable safety
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Outpatients with progressive symptomatology who have demonstrated failure of medical management
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Symptomatic coronary artery disease
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Asymptomatic coronary artery disease with impaired systolic function
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Tier 3 (60–80% inpatient Covid-19 load, severe reduction in operative capacity)
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All in-patients who cannot be discharged safely without surgical intervention/correction, including emergency services
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All patients who are outpatients
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Patients deteriorating while waiting would need to meet criteria for admission before consideration for surgery
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Tier 4 (> 80% inpatient Covid-19 load, minimal operative capacity)
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Only emergency services based on resource availability
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All inpatients judged to be stable and capable of waiting
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All outpatients
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