Beyond the stethoscope: managing ambulatory heart failure during the COVID‐19 pandemic

Abstract

There have been nearly 70 million cases of COVID-19 worldwide, with over 1.5 million deaths at the time of this publication. This global pandemic has mandated dramatic changes in healthcare delivery with a particular focus on social distancing in order to reduce viral transmission. Heart failure patients are among the highest utilizers of health care and are at increased risk for COVID-related vulnerabilities. Effectively managing this complex and resource-intensive patient population from a distance presents new and unique challenges. Here, we review relevant data on telemedicine and remote monitoring strategies for heart failure patients and provide a framework to help providers treat this population during the COVID-19 pandemic. This includes (i) dedicated pre-visit contact and planning (i.e. confirm clinical appropriateness, presence of compatible technology, and patient comfort); (ii) utilization of virtual clinic visits (use of telehealth platforms, a video-assisted exam, self-reported vital signs, and weights); and (iii) use of existing remote heart failure monitoring sensors when applicable (CardioMEMS, Optivol, and HeartLogic). While telemedicine and remote monitoring strategies are not new, these technologies are emerging as an important tool for the effective management of heart failure patients during the COVID-19 pandemic. In general, these strategies appear to be safe; however, additional data will be needed to determine their effectiveness with respect to both process and outcomes measures.

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

“…Challenges to its implementation are the lack of reimbursement, the adherence to therapeutic protocols by physicians and patients, and the need for significant changes in hospitals' workflows or data overload [57,[66][67][68]. Telemedical monitoring is particularly relevant to prevent hospitalization and reduce the requirement for "face to face" follow-up, for example, to keep social distancing during the current COVID-19 pandemic [69,70]. Indeed, the advancement of digital health strategy, including smartphones, wearables, and telemedical monitoring, maybe an unexpected outcome of the COVID-19 pandemic [71,72].…”

The relevance of specific heart failure outpatient programs in the COVID era: an appropriate model for every disease

“…Smart watches and smartphones can measure the heart rate (HR) and heart rhythm through a single lead electrocardiography (ECG) or photoplethysmography by calculating beatto-beat time intervals. ECG sensors are available in various forms, and are the gold standard for HR and heart rhythm measurement, since in HF patients heart rate variability provides independent information on the clinical status and the prognosis [74,75]. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads, which is then streamed via Bluetooth to any smartphone [76].…”

The Association of COVID-19 on Organizational Attitudes in Primary Care Among Interprofessional Practice Clinics

“…THE CORONAVIRUS DISEASE-2019 (COVID-19) pandemic demanded extraordinary changes to health care in a short span of time. In early 2020, ambulatory care across the United States adapted an in-person to virtual care model seemingly overnight ( Al-Tawfiq et al, 2020 ; Oseran et al, 2021 ; Reza et al, 2020 ). In Alabama, this transition happened in February of 2020 when our health system announced the first COVID-19-positive case ( Alabama Public Health, 2021 ).…”