Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

Abstract

Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the COVID-19 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in PAH patients demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.

Factors determining change in treatment for ambulatory children with pulmonary arterial hypertension: Implications for monitoring

“…Our findings may have implications for care of pediatric PAH during the pandemic and in an era of virtual health care visits. During the pandemic, clinicians and patients have understandably sought to minimize risks of exposure to protect both the clinical team and the patients through telehealth, 11 a particularly compelling consideration for pediatric PAH at a time when many children are yet not fully vaccinated against coronavirus. One goal of our study was to explore whether virtual visits could substitute for more regular, face to face in‐clinic assessments.…”

“…Providers and patients have shifted to virtual or telehealth visits in response to the pandemic, to maximize the safety of children with serious cardiopulmonary disease. The complex and variable etiology of pediatric PAH, as well as the high risk of clinical worsening, 9 underscores the importance of establishing evidence‐based guidelines when opting for virtual visits 10–12 . Similar to a face‐to‐face office visit, a virtual visit allows patients to report their symptoms and adherence to treatment.…”

“…Similar to a face‐to‐face office visit, a virtual visit allows patients to report their symptoms and adherence to treatment. However, the lack of cardiac imaging, laboratory studies, and PE places virtual visits at variance with previous standards of care 11,12 . It is uncertain if symptom reporting and limited video examination are sufficient for understanding the clinical needs of the pediatric PAH patient, and there are no data to define the adequacy of telehealth for pediatric PAH patients.…”

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

“…We report below the main remote strategies that clinicians could adopt with this goal [ 40 ]: Questionnaires investigating patients level of activity, such as the Duke activity Status Index (DASI), a self-assessment tool including 12 questions, validated in patients with HF and chronic obstructive pulmonary diseases but not yet in PAH patients [ 41 , 42 ]. In the setting of PAH, Highland K.B.…”

Management of COVID-19 in Patients with Pulmonary Arterial Hypertension

“…Especially in the earlier phases of the pandemic, it was important to streamline chronic outpatient care to achieve two goals: (i) offload physicians who dealt with increasing workload in the inpatient service and (ii) protect patients from an environment of increased infection risk such as the outpatient health services. Telehealth programs exploit the advantage of video conference and have been introduced during the pandemic in order to remotely evaluate and monitor the symptoms and functional status of patients ( 25 ). Although telemonitoring does not permit a comprehensive physical examination or extensive diagnostic tests, it has been increasingly used, and according to our experience they help expert centers reach medical decisions regarding interventions and therapy titration ( 26 ).…”