Telemedicine Outpatient Cardiovascular Care During the COVID-19 Pandemic

Eberly, Lauren A.; Khatana, Sameed Ahmed M.; Nathan, Ashwin S.; Snider, Christopher K.; Julien, Howard; Deleener, Mary Elizabeth; Adusumalli, Srinath

doi:10.1161/circulationaha.120.048185

Cited by 201 publications

(183 citation statements)

References 2 publications

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“…There was a substantial decline in outpatient cardiology visits during the initial COVID-19 pandemic compared with the same period in the year prior, despite the implementation of telehealth in 2020. 2 , 6 Individuals who utilized telehealth tended to be younger with fewer co-morbidities, while those who cancelled or deferred care had similar characteristics to those with in-person visits. Telehealth visits were associated with fewer orders for diagnostic testing, labs, and medications compared with in-person visits.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care

Wosik

Clowse

Overton

et al. 2021

American Heart Journal

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Background The COVID-19 pandemic brought about abrupt changes in the way health care is delivered, and the impact of transitioning outpatient clinic visits to telehealth visits on processes of care and outcomes is unclear. Methods We evaluated ordering patterns during cardiovascular (CV) telehealth clinic visits in the Duke University Health System between March 15 - June 30, 2020 and 30-day outcomes compared with in-person visits in the same time frame in 2020 and in 2019. Results Within the Duke University Health System, there was a 33.1% decrease in the number of outpatient CV visits conducted in the first 15 weeks of the COVID-19 pandemic, compared with the same time period in 2019. As a proportion of total visits initially booked, 53% of visits were cancelled in 2020 compared to 35% in 2019. However, patients with cancelled visits had similar demographics and comorbidities in 2019 and 2020. Telehealth visits comprised 9.3% of total visits initially booked in 2020, with younger and healthier patients utilizing telehealth compared with those utilizing in-person visits. Compared with in-person visits in 2020, telehealth visits were associated with fewer new (31.6% for telehealth vs 44.6% for in person) or refill (12.9% vs 15.6%, respectively) medication prescriptions, ECGs (4.3% vs 31.4%), laboratory orders (5.9% vs 21.8%), echocardiograms (7.3% vs 98.%), and stress tests (4.4% vs 6.6%). When adjusted for age, race, and insurance status, those who had a telehealth visit or cancelled their visit were less likely to have an emergency department (ED) or hospital encounter within 30 days compared with those who had in-person visits (aRR 0.76 [95% 0.65, 0.89] and aRR 0.71 [95% 0.65, 0.78], respectively). Conclusions In response to the perceived risks of routine medical care affected by the COVID-19 pandemic, different phenotypes of patients chose different types of outpatient cardiology care. A better understanding of these differences could help define necessary and appropriate mode of care for cardiology patients.

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Section: Discussionmentioning

confidence: 99%

“…We sought to investigate trends in outpatient cardiology practices at our institution during the early COVID-19 period. 6 …”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care

Wosik

Clowse

Overton

et al. 2021

American Heart Journal

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“…However, the use of this technology may also exacerbate health care disparities. In a recent study with 2,940 patients, those with poor socioeconomic status, older age, and non-English speaking had less access to care via telemedicine, particularly video telemedicine (38).…”

Section: Geographical Impactmentioning

confidence: 97%

The COVID-19 Pandemic Impact on Cardio-Oncology: Results From the COVID-19 International Collaborative Network Survey.

Sadler

DeCara

Herrmann

et al. 2020

Preprint

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BackgroundRe-allocation of resources during the COVID-19 pandemic has resulted in delays in care delivery to patients with cardiovascular disease and cancer. The ability of health care providers to provide optimal care in this setting has not been formally evaluated.ObjectivesTo assess the impact of COVID-19 resource re-allocation on scheduling, testing, elective procedures, telemedicine access, use of new COVID-19 therapies, and providers’ opinions on healthcare policies among oncology and cardiology practitioners.MethodsAn electronic survey was conducted by a cardio-oncology collaborative network through regional and state chapters of the American College of Cardiology , American Society of Clinical Oncology, and the International Cardio-Oncology Society. Descriptive statistics were reported by frequency and proportion for analyses, and stratified categorically by geographic region and specialty.Results1,415 providers (43 countries) participated: 986 cardiologists, 306 oncologists, and 118 trainees/internal medicine. 63% (195/306) of oncologists vs 92% (896/976) of cardiologists reported cancellations of treatments/elective procedures (p=0.01). 46% (442/970) of cardiologists and 25% (76/303) of oncologists modified the scope of their practice (p=<0.001). Academic physicians (74.5%) felt better supplied with personal protective equipment (PPE) vs non-academic (74.5% vs 67.2%; p=0.018). Telemedicine was less common in Europe 81% (74/91), and Latin America 64% (101/158), than the United States, 88% (950/1,097) (p=<0.001). 95% of all groups supported more active leadership from medical professional societies.ConclusionsThese results support initiatives to promote expanded coverage for telemedicine, increased access to PPE, better testing availability and involvement of medical professional societies to help with preparedness for future health care crisis.Appendix: Link to the Survey: https://www.surveymonkey.com/r/C8ZDYNW

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“…Nevertheless, the use of digital technology may further increase disparities. A recent study evaluating telehealth in cardiac clinics suggested disparate use of video encounters in low income and black patients [ 64 ]. Of the 2940 patients scheduled for a telehealth encounter during the study, 1339 (46%) completed telehealth encounters and 1601 (54%) patients had a canceled/no-show visit.…”

Section: Telehealth and Hypertension In The Covid-19 Eramentioning

confidence: 99%

“…On unadjusted analysis, patients with a completed telehealth visit were slightly older, more likely to be male and speak English. However, low income and black patients were less likely to video visits possibly related to insurance coverage [ 64 ]. More investigation is warranted in the future to understand the risks and benefits of video telehealth encounters to enhance cardiac care.…”

Section: Telehealth and Hypertension In The Covid-19 Eramentioning

confidence: 99%

State-of-the-Art review: Hypertension practice guidelines in the era of COVID-19

Ferdinand¹,

Vo²,

Echols³

2020

American Journal of Preventive Cardiology

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The global burden of hypertension (HTN) is immense and increasing. In fact, HTN is the leading risk factor for adverse cardiovascular disease outcomes. Due to the critical significance and increasing prevalence of the disease, several national and international societies have recently updated their guidelines for the diagnosis and treatment of HTN. In consideration of the COVID-19 pandemic, this report provides clinicians with the best strategies to prevent HTN, manage the acute and long-term cardiac complications of HTN, and provide the best evidence-based care to patients in an ever-changing healthcare environment. The overarching goal of the various HTN guidelines is to provide easily accessible information to healthcare providers and public health officials, which is key for optimal clinical practice. However, the COVID-19 pandemic has challenged the ability to provide safe care to the most vulnerable hypertensive populations throughout the world. Therefore, this review compares the most recent guidelines of the 2017 American College of Cardiology/American Heart Association and multiple U.S. societies, the 2018 European Society of Cardiology/European Society of Hypertension, the 2019 National Institute for Care and Health Excellence, and the 2020 International Society of Hypertension. While a partial emphasis is placed on the management of HTN in the midst of COVID-19, this review will summarize current concepts and emerging data from the listed HTN guidelines on the diagnosis, monitoring, management, and evidence-based treatments in adults.

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Telemedicine Outpatient Cardiovascular Care During the COVID-19 Pandemic

Cited by 201 publications

References 2 publications

Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care

Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care

The COVID-19 Pandemic Impact on Cardio-Oncology: Results From the COVID-19 International Collaborative Network Survey.

State-of-the-Art review: Hypertension practice guidelines in the era of COVID-19

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