Impact of COVID-19 Pandemic on Cardiac Electronic Device Management and Role of Remote Monitoring

Magnocavallo, Michele; Vetta, Giampaolo; Bernardini, Alessia; Piro, Agostino; Mei, Maria Chiara; Iorio, Martina Di; Mariani, Marco Valerio; Rocca, Domenico G. Della; Severino, Paolo; Quaglione, Raffaele; Giunta, Gaetano; Chimenti, Cristina; Miraldi, Fabio; Vizza, Carmine Dario; Fedele, Francesco

doi:10.1016/j.ccep.2021.10.010

Cited by 12 publications

(5 citation statements)

References 55 publications

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“…Of note, telemedicine use peaked above 75% in all cardiovascular subspecialties during the COVID-19 outbreak, but only clinical electrophysiology maintained a high rate of the virtual modality of care (over 95%) [ 21 ]. In our experience, the COVID-19 outbreak prompted the adoption of RM programs in all patients with CIED who were eligible for a RM strategy, with either at-home delivery or in-office modem pick-up, to provide easier access to valuable information, such as arrhythmic events, acute HF manifestations and device-related issues, without the need for in-person CIED interrogation [ 22 , 23 , 24 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic

Mariani

Pierucci

Forleo

et al. 2023

JCM

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The feasibility and effectiveness of virtual visits (VVs) for cardiac electrophysiology patients are still unknown. We aimed to assess the feasibility and effectiveness of VVs as compared to in-person visits, and to describe patient experience with virtual care in clinical electrophysiology. We prospectively enrolled patients scheduled to receive a clinical electrophysiology evaluation, dividing them in two groups: a VV group and an in-person visit group. Outcomes of interest were: (1) improvement in symptoms after the index visit, (2) disappearance of remote monitoring (RM) alerts at follow-up, (3) necessity of urgent hospitalization and (4) patient satisfaction measured by the Patient Satisfaction Questionnaire-18 (PSQ-18). This study included 162 patients in the VV group and 185 in the in-office visit group. As compared to in-person visits, VVs resulted in a similar reduction in RM alerts (51.5% vs. 43.2%, p-value 0.527) and in symptomatic patient rates (73.6% vs. 56.9%, p-value 0.073) at follow-up, without differences in urgent hospitalization rates (p-value 0.849). Patient satisfaction with VVs was higher than with in-person evaluation (p-value < 0.012). VVs proved to be as feasible and as effective as in-person visits, with high patient satisfaction. A hybrid model of care including VVs and in-person visits may become the new standard of care after the COVID-19 pandemic is over.

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Section: Discussionmentioning

confidence: 99%

The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic

Mariani

Pierucci

Forleo

et al. 2023

JCM

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“…Telemedicine through dedicated applications, telephone calls, or virtual visits emerged as an alternative way of caring for cardiovascular patients. [12][13][14] Remote monitoring of CIEDs was used widespread before 2020 but the epidemic boosted it. Initially developed to allow early diagnosis of device malfunction, CIEDs telemedicine systems were subsequently upgraded to transmit several alerts regarding not only leads and battery, but also the occurrence of arrhythmias and abnormalities in physiological parameters (such as heart rate variability or thoracic impedance).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, physicians and patients were often reluctant to perform in-person scheduled follow-up visits because of the risk of infection. Telemedicine through dedicated applications, telephone calls, or virtual visits emerged as an alternative way of caring for cardiovascular patients 12–14 …”

Section: Discussionmentioning

confidence: 99%

“…Remote monitoring of CIEDs was used widespread before 2020 but the epidemic boosted it. Initially developed to allow early diagnosis of device malfunction, CIED telemedicine systems were subsequently upgraded to transmit several alerts regarding not only leads and battery, but also the occurrence of arrhythmias and abnormalities in physiological parameters (such as heart rate variability or thoracic impedance) 12,14 . Because of these peculiar characteristics, the use of CIED remote monitoring had the potential not only to replace in-office technical checks but also to actively monitor the cardiovascular health of patients and potentially mitigate the adverse consequences of the epidemic (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Impact of coronavirus disease 19 outbreak on arrhythmic events and mortality among implantable cardioverter defibrillator patients followed up by remote monitoring: a single center study from the Veneto region of Italy

Zorzi

Mattesi²,

Frigo

et al. 2022

Journal of Cardiovascular Medicine

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Background The 2020 severe acute respiratory syndrome coronavirus 2 outbreak entailed reduced availability of traditional (in-office) cardiology consultations. Remote monitoring is an alternative way of caring that may potentially mitigate the negative effects of the epidemic to the care of cardiovascular diseases. We evaluated the outcome of implantable cardioverter defibrillator (ICD) carriers followed up remotely in 2020 (epidemic period) versus 2019 (control). Methods We included all patients with an ICD who remained remotely monitored from the beginning to the end of each year. The combined end point included: new-onset atrial fibrillation; sustained ventricular tachycardia >170 bpm without ICD intervention; appropriate ICD intervention (either shock or antitachycardia pacing); any-cause death. Multiple events in the same patients were counted separately if occurring ≥48 h apart. Results In 2020, 52 end points occurred in 37 of 366 (10%) ICD carriers [0.14/patient (95% confidence interval [CI] = 0.11–0.19)] versus 43 end points in 32 of 325 (10%) ICD carriers in 2019 [0.13/patient (95% CI = 0.10–0.18) P = 0.75]. There was no difference between the distribution of any individual end point in 2020 versus 2019 although a nonsignificant mortality increase was observed (from 2.8% to 4.6%, P = 0.19). The lowest weekly event rate occurred during the national lock down in spring 2020 but a similar trend occurred also in 2019 suggesting that the effect may not be linked to social distancing measures. Conclusions We did not observe an increase in a combined end point including arrhythmic events and mortality in ICD carriers who were remotely monitored in 2020, compared to 2019, despite the negative impact of the coronavirus disease 2019 outbreak on the healthcare system.

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“…The COVID‐19 pandemic necessitated significant innovation to protect patients and to maintain established levels of care for patients with cardiac implantable electronic devices (CIED) 1,2 . Specific high‐risk groups were identified for complications from COVID early, including the elderly and those with chronic medical conditions.…”

Section: Figurementioning

confidence: 99%

Car park clinic: “Driving” clinic innovation in cardiac electrophysiology?

Sears

Khant

2023

Cardiovasc electrophysiol

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The COVID-19 pandemic necessitated significant innovation to protect patients and to maintain established levels of care for patients with cardiac implantable electronic devices (CIED). 1,2 Specific high-risk groups were identified for complications from COVID early, including the elderly and those with chronic medical conditions. Cardiac electrophysiology (EP) clinics are often filled with elderly and frail patients who may or may not have access to remote monitoring.Remote monitoring has consistently demonstrated significant broad health benefits, cost savings, and high patient satisfaction. 3,4 Nonetheless, disparities in remote monitoring follow-up have been identified, such that patients who were younger, European American, collegeeducated, higher income, and active on patient portals were more likely to be active with remote monitoring of their CIED. 5 Specifically, older CIED patients have reported that they have significantly less interest in remote data transfer. 6 The desire for face-to-face (FTF) care may point to the value patients receive in clinic including: reassurance, emotional support, and positive reinforcement for health behaviors. EP clinics are | © 2023 Wiley Periodicals LLC. Cardiac EP can be proud of its ongoing innovative spirit throughout its history. Pairing innovation with patient centric care may require new maps of care to accommodate our patients. The COVID era prompted change in clinical care, but our ongoing openness to change and patient centric care models will drive the future of our disciplines.

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Impact of COVID-19 Pandemic on Cardiac Electronic Device Management and Role of Remote Monitoring

Cited by 12 publications

References 55 publications

The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic

The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic

Impact of coronavirus disease 19 outbreak on arrhythmic events and mortality among implantable cardioverter defibrillator patients followed up by remote monitoring: a single center study from the Veneto region of Italy

Car park clinic: “Driving” clinic innovation in cardiac electrophysiology?

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