Telemedicine and the Forgotten America

Julien, Howard; Eberly, Lauren A.; Adusumalli, Srinath

doi:10.1161/circulationaha.120.048535

Cited by 51 publications

(48 citation statements)

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“…Therefore, it is necessary to heighten awareness and self-protection measures to reduce morbidity and mortality in individuals with CVD and related conditions. In addition, telemedicine affords a further potential means to access healthcare in rural communities and allow routine follow-up for individuals with CVD [95].…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular Manifestations and Mechanisms in Patients with COVID-19

Dou

Wei

Zhou

et al. 2020

Trends in Endocrinology & Metabolism

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COVID-19 patients with preexisting cardiovascular diseases or with cardiovascular complications have showed a higher risk of mortality. The main cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction, myocarditis, arrhythmia, heart failure, shock, and venous thromboembolism/pulmonary embolism. COVID-19 could cause cardiovascular complications or deterioration of coexisting cardiovascular diseases through direct or indirect mechanisms, including viral toxicity, dysregulation of the renin–angiotensin–aldosterone system, endothelial cell damage and thromboinflammation, cytokine storm, and demand-supply mismatch of oxygen. This study systematically reviews cardiovascular manifestations, histopathology, and mechanisms of COVID-19, to help formulate future research goals and facilitate the development of therapeutic management strategies.

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Section: Resultsmentioning

confidence: 99%

Cardiovascular Manifestations and Mechanisms in Patients with COVID-19

Dou

Wei

Zhou

et al. 2020

Trends in Endocrinology & Metabolism

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“…The indication from the World Health Organization on the use of prophylactic LMWH doses in patients with COVID-19 [ 11 ] was essentially based on preliminary evidence showing a benefit compared to no thrombo-prophylaxis, mainly in subgroups at higher risk [ 8 , 9 ]; such recommendation was consistent with pre-existing guidelines for thrombo-prophylaxis in high-risk acutely ill patients [ 18 – 20 ]. However, small observational studies demonstrated rates > 20% of thrombotic complications among critically ill patients with COVID-19, despite standard thrombo-prophylaxis [ 3 , 9 , 21 ]. Although flawed by the use of heterogeneous agents and variable dosages, these reports generated a source of concern and encouraged the use of intermediate or full-dose anticoagulation in this setting.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19

Mennuni

Renda

Grisafi

et al. 2021

J Thromb Thrombolysis

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A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400–0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study.

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“…Thus, only 558 (21.3%) among those who performed physical activity used web tutorials or apps. Inexperience in the use of telemedicine tools, and in many cases the non-existence of updated patient databases, increased the lack of connection between the health teams and patients with cardiometabolic disease, particularly in public health systems belonging to low and middle incomes countries [ 21 22 23 ]. The absence of adequate follow-up of patients lead to missed opportunities, such as that offered by 52.3% of active smokers, who reported that they had contemplated quitting smoking [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study

Santi

Márquez

Piskorz

et al. 2021

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Background: SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods: A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results: A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08–2.24; p = 0.018), heart failure (OR 1.36, CI 1.05–1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04–1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26–1.70; p < 0.01). Conclusions: Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.

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Telemedicine and the Forgotten America

Cited by 51 publications

References 0 publications

Cardiovascular Manifestations and Mechanisms in Patients with COVID-19

Cardiovascular Manifestations and Mechanisms in Patients with COVID-19

Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19

Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study

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