Challenges for Management of Dilated Cardiomyopathy during COVID-19 Pandemic—A Telemedicine Application

Abstract

Background and Objectives: The 2019 coronavirus pandemic (COVID-19) represented a significant challenge for the medical community. The first aim of this study was to examine the COVID-19 impact on the follow-up of patients with dilated cardiomyopathy (DCM) and to establish the advantages of multiparametric home monitoring. Also, we tried to establish the main prognostic predictors at 2-years follow-up and the value of LV diastolic filling pattern (LVDFP) in increasing mortality and morbidity. Materials and Methods: We conducted a prospective study of 142 patients with DCM assessed by in-patient visit in the pre-pandemic period and hybrid (face-to-face, online consultation and telemedicine home monitoring with a dedicated application) during the pandemic period. The statistical analysis compared the strategy used in the pre-pandemic with management during the pandemic, in terms of clinical assessment, hospitalizations/emergency room visits due to HF exacerbation and total mortality. Results: We did not observe significant changes in blood pressure (BP), heart rate (FC), weight and symptoms or an increased rate of adverse drug events between the two periods. We successfully titrated HF medications with close monitoring of HF decompensations, which were similar in number, but were mostly managed at home during the pandemic. There was also no statistically significant difference in emergency room visits due to severe decompensated HF. Mortality in the first and second year of follow-up was between 12.0 and 13%, similar in the pre-pandemic and pandemic periods, but significantly higher in patients with restrictive LVDFP. Clinical improvement or stability after 2 years was more frequent in patients with nonrestrictive LVDFP. The main prognostic predictors at 1 and 2-years follow-up were: the restrictive LVDFP, significantly dilated LV, comorbidities (DM, COPD), older age, associated severe mitral regurgitation and pulmonary hypertension. Conclusions: The pandemic restrictions determined a marked decrease of the healthcare use, but no significant change in the clinical status of DCM patients under multiparametric home monitoring. At 2-years follow-up, the presence of the restrictive LVDFP was associated with an increased risk of death and with a worse clinical status in DCM patients.

Challenges in Caring for People with Cardiovascular Disease through and beyond the COVID-19 Pandemic: The Advantages of Universal Access to Home Telemonitoring

“…This is the first study analyzing the impact of telemedicine on cardiovascular counseling and testing during the COVID-19 pandemic in Romania. Our results support the ongoing use of telemedicine as a means to improve patient access to cardiovascular counseling and testing services [ 10 , 21 , 22 , 23 , 24 ].…”

“…Telemedicine is a useful tool to provide support and care to stable patients, reserving direct patient–provider contact for emergent/urgent situations [ 8 ]. During the pandemic, new applications and platforms for doctor–patient interaction were developed, thus providing a unique opportunity to improve preventive care [ 9 , 10 , 11 ]. In this context, we immediately adapted our dedicated application in order to maintain follow-up with stable patients with the minimum physical contact possible and we reserved the in-person evaluations and interventions for urgent situations or unstable patients.…”

Telemedicine for Optimizing Secondary Prevention in Coronary Artery Bypass Grafting Patients during COVID-19 Pandemic

“…On the other hand, looking back, the pandemic brought new platforms for interacting with patients eager to engage, presenting a unique opportunity to reset how we approach preventive care. One of the many lessons the pandemic has taught us regarding the care of patients with CVD is how quickly the field of telemedicine has advanced in response to such challenging circumstances [11,12,[27][28][29]. The overnight adoption of telemedicine applications for monitoring patients with CVD, but also for preventive cardiology, is the most obvious example.…”

“…On the other hand, the pandemic helped us find alternative methods, such as the development of telemedicine, to provide support and care to stable patients. Thus, new applications and platforms have been developed for doctor-patient interaction, improving both remote monitoring of chronic patients and preventive care [11][12][13][14].…”

Importance of Tissue Doppler Evaluation in Dilated Cardiomyopathy: The Value of Diastolic Filling Pattern as a Prognostic Predictor

“…The study population consisted of a prospective cohort of 142 patients with DCM, followed between 1 January 2018 and 1 January 2023 at a single center (Cardioclass clinic for cardiovascular disease, an ambulatory cardiology clinic, one of the few with a telemedicine application dedicated to follow up patients with HF). The patients enrolled in the study also participated in the development of the telemedicine application for HF during the COVID-19 pandemic [ 13 ]. Patients were eligible for enrolment into the study if they were diagnosed with DCM and had been evaluated in the clinic and registered in the dedicated application within the previous 12 months.…”