Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology

Khera, Amit; Baum, Sharon; Gluckman, Tyler J; Gulati, Martha; Martin, Seth S.; Michos, Erin D.; Návar, Ann Marie; Taub, Pam R.; Tóth, Peter P.; Virani, Salim S.; Wong, Nathan D.; Shapiro, Michael D.

doi:10.1016/j.ajpc.2020.100009

Cited by 107 publications

(114 citation statements)

References 66 publications

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“…A 33-item questionnaire was developed by the investigators to examine the objectives of this study (Online Appendix 1). Non-COVID-related questionnaire items were based on ICCPR's previous CR program survey [18]. The questionnaire was divided into three sections:…”

Section: Methodsmentioning

confidence: 99%

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Ghisi¹,

Liu

et al. 2020

Preprint

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BackgroundTo investigate impacts of COVID-19 on CR delivery around the globe, including effects on providers and patients.MethodsIn this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April-June/2020. The 50 members of the ICCPR and personal contacts facilitated program identification.ResultsOverall, 1062(18.3% program response rate) responses were received from 70/111(63.1% country response rate) countries in the world with existent CR programs. Of these, 367(49.1%) programs reported they had stopped CR delivery, and 203(27.1%) stopped temporarily (mean=8.3±2.8weeks). Alternative models were delivered in 322(39.7%) programs, primarily through low-tech modes (n=226,19.3%). 353(30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean=30.0%±27.4/100). 266(22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113(9.7%) reported increased workload to transition to remote delivery, and 105(9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n=333,28.4%), how to use technology to interact with the program (n=329,27.9%), having to stop their exercise because they have no place to exercise (n=303,25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n=249,21.2%). Respondents perceived staff (n=488,41.3%) and patient (n=453,38.6%) personal protective equipment, as well as COVID-19 screening (n=414,35.2%) and testing (n=411,35.0%) as paramount to in-person service resumption.ConclusionApproximately 4400 programs ceased service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges.Highlights-COVID-19 has impacted cardiac rehabilitation (CR) delivery around the globe.-In this cross-sectional study, a survey was completed by 1062 (18.3%) CR programs from 70 (63.1%) countries.-The pandemic has resulted in cessation of ∼75% of CR programs, with others ceasing initiation of new patients, reducing components delivered, and/or changing of mode delivery with little opportunity for planning and training.-There is also significant psychosocial and economic impact on CR providers.-Alternative CR model (e.g. home-based, virtual) reimbursement advocacy is needed, to ensure safe, accessible secondary prevention delivery.

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Section: Methodsmentioning

confidence: 99%

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Ghisi¹,

Liu

et al. 2020

Preprint

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“…140 Thus, while the evidence for DHI and telehealth is heterogeneous in CV risk factor management, a key determinant of success appears to be clinician review of patient-generated data linked to actual changes in medical management and the involvement of a broader healthcare team than just a single physician. 114 The very best examples of telehealth in the literature improved patient satisfaction, knowledge, and self-efficacy, in addition to CV risk factors like BP levels and HbA1c. Many barriers remain, for example: devising means of transmitting clinical data accessible to patients of varying ages and skill; appropriate remuneration for telemedicine activities; availability of technical support; and navigating new workflows.…”

Section: Telehealth For Diabetes Carementioning

confidence: 99%

Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management

Lau

McAlister

2021

Canadian Journal of Cardiology

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COVID-19 and our public health responses to the pandemic may have far-reaching implications for cardiovascular risk affecting the general population and not just survivors of COVID-19. In this narrative review, we discuss how the pandemic may impact general cardiovascular risk for years to come, and explore the mitigating potential of telehealth interventions. From a health care perspective, the shift away from in-person office visits may have led many to defer routine risk factor management and may have had unforeseen effects on continuity of care and adherence. Fear of COVID-19 has led some patients to forego care for acute cardiovascular events. Curtailment of routine outpatient laboratory testing has likely delayed intensification of risk-factor modifying medical therapy, and drug shortages and mis-information may have negatively impacted adherence to antihypertensive, glucose-lowering, and lipid-lowering agents. From a societal perspective, the unprecedented curtailment of social and economic activities has led to income loss, unemployment, social isolation, decreased physical activity, and increased frequency of depression and anxiety, all of which are known to be associated with worse cardiovascular risk-factor control and outcomes. We must embrace and evaluate measures to mitigate these potential harms to avoid an epidemic of cardiovascular morbidity and mortality in the coming years that could dwarf the initial health impacts of COVID-19.

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“…Reduced social and physical contact with others has been shown to cause boredom, frustration, and a sense of isolation [ 10 ]. In addition, there is a concern that prolonged home stay may increase sedentary behaviours, such as spending excessive amounts of time sitting, reclining, or lying down (watching television, reading, using mobile devices) leading to an increased risk for, and potential deterioration of chronic health conditions [ 15 , 16 ] and acute and chronic deconditioning. Evidence suggests that the de-conditioning process (loss of muscle strength and decline in ability to perform activities of daily living) can begin within days of becoming inactive [ 17 ].…”

Section: Contextmentioning

confidence: 99%

Why physical activity matters for older adults in a time of pandemic

Cunningham

Sullivan

2020

Eur Rev Aging Phys Act

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Background The COVID-19 pandemic has impacted communities across the world. Government responses, of promoting ‘social distancing’ at a population level, and ‘self-isolation’ of older adults to mitigate its spread have been unprecedented. Despite the importance of these Public Health and Social Measures (PHSM), they present challenges to maintaining a physically active lifestyle, particularly for older adults. Context The importance of physical activity (PA) for health is well documented. There is strong evidence that PA in later life reduces the risk of disease, helps to manage existing conditions, and develops and maintains physical and mental function. Staying physically active is particularly important for older adults currently. Implications and recommendations Research suggests that PHSM have already reduced levels of PA for older adults during the COVID-19 pandemic. Prior to COVID-19 many older adults were not engaging in enough PA to attain health benefits. Evidence indicates that there will be an increase in the number of older adults not meeting guidelines for PA due to the impacts of COVID-19. This has implications for population health and public health policy. How to support older adults to remain physically active during and after the COVID-19 crisis will require careful consideration. Going forward it is imperative that policy and practice support all older adults to achieve the recommended levels of PA to ensure that they are not disadvantaged in the short- but also in the longer term by the impact of COVID-19.

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Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology

Cited by 107 publications

References 66 publications

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management

Why physical activity matters for older adults in a time of pandemic

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