Distribution, infrastructure, and expertise of heart failure and cardio‐oncology clinics in a developing network: temporal evolution and challenges during the coronavirus disease 2019 pandemic

Abstract

The Hellenic Heart Failure Association has undertaken the initiative to develop a national network of heart failure clinics (HFCs) and cardio‐oncology clinics (COCs). We conducted two questionnaire surveys among these clinics within 17 months and another during the coronavirus disease 2019 outbreak to assess adjustments of the developing network to the pandemic. Out of 68 HFCs comprising the network, 52 participated in the first survey and 55 in the second survey. The median number of patients assessed per week is 10. Changes in engaged personnel were encountered between the two surveys, along with increasing use of advanced echocardiographic techniques (23.1% in 2018 vs. 34.5% in 2020). Drawbacks were encountered, concerning magnetic resonance imaging and ergospirometry use (being available in 14.6% and 29% of HFCs, respectively), exercise rehabilitation programmes (applied only in 5.5%), and telemedicine applications (used in 16.4%). There are 13 COCs in the country with nine of them in the capital region; the median number of patients being assessed per week is 10. Platforms for virtual consultations and video calls are used in 38.5%. Coronavirus disease 2019 outbreak affected provision of HFC services dramatically as only 18.5% continued to function regularly, imposing hurdles that need to be addressed, at least temporarily, possibly by alternative methods of follow‐up such as remote consultation. The function of COCs, in contrast, seemed to be much less affected during the pandemic (77% of them continued to follow up their patients). This staged, survey‐based procedure may serve as a blueprint to help building national HFC/COC networks and provides the means to address changes during healthcare crises.

COVID‐19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology

“… 37 , 38 Limitations in access to care were only partly counterbalanced by use of telehealth. 37 , 39 , 40 …”

Practical Approaches to Build and Sustain a Cardio-Oncology Clinic

“…One of the most difficult steps toward the operation of the cardio-oncology unit is the establishment of follow-up strategies for oncology patients, since data are still limited [ 22 ]. All patients should undergo a cardiovascular evaluation prior to starting chemotherapy treatment that could lead to cardiotoxicity in order to establish a baseline cardiovascular (CV) risk for the upcoming treatment and follow-up.…”

“…Laboratory tests should include lipidemic profile, HbA1c, and cardiac biomarkers, such as troponin and natriuretic peptides [ 23 ]. Further imaging examinations, such as stress echo or 24 h Holter, are indicated for certain patients [ 22 ].…”

“…There are various follow-up protocols depending on the initial cardiovascular toxicity risk and the course of cancer treatment that will be administered [ 22 ]. For example, in patients with a high risk who are about to receive anthracyclines, after the initial assessment, a 3-month re-evaluation via echocardiography is recommended for the first year, every 6 months for four years, and then annually [ 22 ].…”

Heart failure in the course of a pandemic

“…To address this situation, virtual HF clinics offering remote patient consultation have been developed coupled with changes in the organization of established HF clinic networks. 29,30 In the presence of aggravating HF symptoms or symptoms suggestive of COVID-19, the patient should call the treating physician on the phone rather than visiting a medical facility, except for emergency cases. The physician will advise the patient whether a visit to hospital or clinic is necessary.…”