Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

Abstract

The Covid-19 pandemic affected large part of Italy since February 2020; we, therefore, aimed to assess the impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease (CVD) in Italy. We analyzed data from three telemedicine dispatch centers, one located in Genoa, serving private clients (pharmacies, general practitioners), one in Brescia, serving pharmacies, and one in Bari, serving regional public STEMI network and emergency medical service in Apulia (4 million inhabitants). Demographic data and principal electrocardiogram diagnosis were collected and analyzed. Records from the time interval March 1, 2020 and April 1, 2020 were compared with the corresponding period in 2019. The comparative analysis of data shows a 54% reduction of telemedicine electrocardiogram transmission in Genoa telemedicine center (from 364 to 166), 68% in Brescia (from 5.745 to 1.905), 24% in Bari (from 15.825 to 11.716); relative reduction according to electrocardiogram diagnosis was 38% for acute coronary syndrome, 40% for other acute CVD in Genoa center, 24% for acute coronary syndrome, and 38% for other acute CVD in Bari. Male/female ratio remained substantially unchanged. A dramatic reduction of telemedicine access for CVD was observed during Covid-19 outbreak in March 2020 in Italy. The reduction was substantially consistent for all electrocardiogram findings, ACS, other acute CVD and normal.

The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic

“…A dramatic reduction of telemedicine access for CVD was observed in March 2020 in Italy compared with March 2019. The reduction was substantially consistent for all electrocardiogram findings, ACS, other acute CVD and normal [4]. This can be presumably explained by the fear of in-hospital contagion, a congestion of the emergency system overwhelmed by COVID-19 patients and an implementation of precautionary measures against contagion, leading to an increase in STEMI case fatality and major complications.…”

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

“…The proportion of abnormal values (particularly for SpO 2 and BP) was significantly lower during the lockdown [ Figure 3D ]. However, in the same period, access to existing telemedicine and telecounseling services provided to patients daily through community pharmacies and general practices showed a dramatic drop (ranging between 49% and 85%) because of the reduced access of patients to these premises due to fear of contagion [ 109 – 111 ] [ Figure 3A ]. In the pharmacy setting, the overall proportion of abnormal tests was larger during the outbreak [ Figure 3B ]: in particular, an increase in the prevalence of abnormal ECGs due to myocardial ischemia was observed [ 109 ] .…”

A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic

“…The eligibility process applied to the selected references, after the elimination of the duplicated ones, returned 39 works [ 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], including a review focused on the relationship between telemedicine and radiotherapy [ 39 ].…”

“…The study in [ 48 ] described a telemedicine experience in heart failure management during COVID-19. The study in [ 36 ] analyzed data from three telemedicine centers focusing on heart care. The study in [ 40 ] reported the evolution of a multidisciplinary center for myocarditis towards a telemedicine system.…”