Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic

Abstract

Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.

Detecting early physiologic changes through cardiac implantable electronic device data among patients with COVID-19

“…The early detection capabilities of machine learning algorithms leveraging data from CIEDs (such as HeartLogic Index) may also be extended to identify other types of non-heart failure-related decompensation, such as influenza or pneumonia infections, among high-risk groups. Thus, while CIEDs have traditionally been used for cardiac monitoring, including during the pandemic to reduce exposure associated with avoidable in-person cardiac care, 4 , 5 , 16 , 17 this study suggests CIEDs may also be used for surveillance and early detection of other forms of acute decompensation, including but not limited to COVID-19. The ability to follow a high-risk cohort of cardiac patients remotely and receive alerts when they may be in the early stages of an infection may significantly improve clinicians’ early intervention abilities in clinical care.…”

“…Prior studies have demonstrated the power of using CIEDs to remotely monitor patients’ cardiac health at home. 4 , 5 Given the well described, broad effects of COVID-19 on the cardiac and respiratory systems, 6 it is possible that certain CIED sensors may also detect a COVID-19 infection, potentially before symptom onset. The potential to use CIEDs to identify early signs of COVID-19 has not been well explored beyond small case series studies.…”

Can Patients with Electrolyte Disturbances Be Safely and Effectively Treated in a Hospital-at-Home, Telemedicine-Controlled Environment? A Retrospective Analysis of 267 Patients

“…Our study shows that electrolyte disturbances are common in the setting of virtual medical telemedicine; nevertheless, it seems prudent enough to manage these patients at home without continuous cardiac rhythm monitoring [ 48 ].…”

The Recent Advances of Mobile Healthcare in Cardiology Practice

“…In addition, it has been shown that digital health platforms can be effectively employed to assist the patients with other cardiologic pathologies such as arrhythmias and atrial fibrillation ( 123 - 126 ). The results of a number of the studies demonstrated that patients diagnosed with cardiovascular disorders can potentially benefit from the application of mHealth in cardiology.…”