Key Points Question Is the transition to remote cardiology ambulatory visits during the COVID-19 pandemic associated with disparities in patient access to care, ordering of diagnostic tests, and/or medication prescribing? Findings In this cross-sectional study of 176 781 ambulatory cardiology visits, patients using COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals, have private insurance, and have cardiovascular comorbidities. Compared with pre-COVID in-person visits, clinicians during COVID-era video and telephone visits had a significantly lower odds of ordering any medication as well as most tests. Meaning Remote cardiology clinic visits were used more often by certain traditionally underserved patient groups but were also associated with less frequent testing and prescribing.

The field of cardiology has long used wearable medical devices to monitor heart rate and rhythm. The past decade has seen the emergence of many new wearable devices, including several that have been widely adopted by both physicians and consumers. In this review, we discuss existing and forthcoming devices designed to measure activity, heart rate, heart rhythm, and thoracic fluid. We also offer several frameworks to classify and better understand wearable devices, such that we may weigh their potential benefit in improving healthcare with the many challenges that must be addressed to reap these benefits.

Aim Sequential testing by coronary computed tomography angiography (CTA) and myocardial perfusion SPECT (MPS) obtained on standalone scanners may be needed to diagnose coronary artery disease (CAD) in equivocal cases. We have developed an automated technique for MPS-CTA registration and demonstrate its utility for improved MPS quantification by guiding the co-registered physiological (MPS) with anatomical CTA information. Methods Automated registration of MPS left ventricular (LV) surfaces with CTA coronary trees was accomplished by iterative minimization of voxel differences between pre-segmented CTA volumes and “motion-frozen” MPS data. Studies of 35 sequential patients (26 males), mean age 67±12 years with 64-slice coronary CTA, MPS and with available results of the invasive coronary angiography performed within 3 months were retrospectively analyzed. 3D coronary vessels and CTA slices were extracted and fused with quantitative MPS results mapped on LV surfaces and MPS coronary regions. Automatically co-registered CTA images and extracted trees were used to correct the MPS contours and to adjust the standard vascular region definitions for MPS quantification. Results Automated co-registration of MPS and coronary CTA had the success rate of 96% as assessed visually; the average errors were 4.3±3.3 mm in translation and 1.5±2.6 deg in rotation on stress and 4.2±3.1 mm in translation and 1.7±3.2 deg in rotation on rest. MPS vascular region definition was adjusted in 17 studies and LV contours were adjusted in 11 studies using co-registered CTA images as a guide. CTA-guided MP analysis resulted in improved area under the receiver operator characteristics (ROC) curves for the detection of RCA and LCX lesions as compared to standard MPS analysis 0.84±0.08 vs. 0.70±0.11 for LCX (p = 0.03) and 0.92±0.05 vs. 0.75±0.09 (p=0.02) for RCA. Conclusions Software image co-registration of standalone coronary CTA and MPS obtained on separate scanners can be performed rapidly and automatically allowing CTA-guided contour and vascular territory adjustment on MPS for improved quantitative MPS analysis.

Background: An unprecedented shift to remote heart failure outpatient care occurred during the coronavirus disease 2019 (COVID-19) pandemic. Given challenges inherent to remote care, we studied whether remote visits (video or telephone) were associated with different patient usage, clinician practice patterns, and outcomes. Methods: We included all ambulatory cardiology visits for heart failure at a multisite health system from April 1, 2019, to December 31, 2019 (pre-COVID) or April 1, 2020, to December 31, 2020 (COVID era), resulting in 10 591 pre-COVID in-person, 7775 COVID-era in-person, 1009 COVID-era video, and 2322 COVID-era telephone visits. We used multivariable logistic and Cox proportional hazards regressions with propensity weighting and patient clustering to study ordering practices and outcomes. Results: Compared with in-person visits, video visits were used more often by younger (mean 64.7 years [SD 14.5] versus 74.2 [14.1]), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%) individuals ( P <0.05 for all). Remote visits were more frequently used by non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person). During remote visits, clinicians were less likely to order diagnostic testing (odds ratio, 0.20 [0.18–0.22] video versus in-person, 0.18 [0.17–0.19] telephone versus in-person) or prescribe β-blockers (0.82 [0.68–0.99], 0.35 [0.26–0.47]), mineralocorticoid receptor antagonists (0.69 [0.50–0.96], 0.48 [0.35–0.66]), or loop diuretics (0.67 [0.53–0.85], 0.45 [0.37–0.55]). During telephone visits, clinicians were less likely to prescribe ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers)/ARNIs (angiotensin receptor-neprilysin inhibitors; 0.54 [0.40–0.72]). Telephone visits but not video visits were associated with higher rates of 90-day mortality (1.82 [1.14–2.90]) and nonsignificant trends towards higher rates of 90-day heart failure emergency department visits (1.34 [0.97–1.86]) and hospitalizations (1.36 [0.98–1.89]). Conclusions: Remote visits for heart failure care were associated with reduced diagnostic testing and guideline-directed medical therapy prescription. Telephone but not video visits were associated with increased 90-day mortality.