The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure

Abstract

Background We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. Methods Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. Results Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. Conclusions HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.

The Impacts of COVID-19 on Healthcare Quality in Tertiary Medical Centers—A Retrospective Study on Data from Taiwan Clinical Performance Indicators System

“…Elective medical services declined markedly during the outbreak of COVID-19 in Taiwan [ 12 ]. The same phenomenon was observed similarly all over the world [ 2 , 3 , 4 , 6 , 7 ]. People were less willing to visit a hospital for fear of COVID-19, which was known to be contagious disease at the outset of the outbreak [ 13 ].…”

“…The COVID-19 pandemic has resulted in an extensive transformation of health care systems worldwide [ 2 ]. A previous report from a single institute in Thailand found that readmission rates for heart failure patients were significantly lower during the peak of the COVID-19 pandemic and were slightly increased during the post-peak period of the COVID-19 pandemic in those managed with telemedicine [ 3 ]. Another single institute study from the United Kingdom revealed that postoperative infection after emergency general surgery during the COVID-19 pandemic was similar to that of the pre-COVID-19 period [ 4 ].…”

Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America

“… 104 Though virtual visits have been associated with better adherence to clinic follow-up (likely related to the relative ease of access and reduced burden of transportation), 105 video examination alone (without supplemental remote monitoring and laboratory data) may be particularly challenging in the evaluation of high-risk patients who need careful and safe adjustment of guideline-directed medical therapies. 106 , 107 Although assessing jugular venous distension and lower extremity edema by video examination is possible, supplemental data to inform intravascular volume status are frequently necessary for optimal decision-making. 67 , 108 The impact of televisits in place of in-person visits on outcomes is unknown and requires investigation.…”

The impact of the COVID-19 pandemic on heart failure management: Global experience of the OPTIMIZE Heart Failure Care network

“…A decrease in emergency HF admissions was commonly reported by OPTIMIZE contributors, along with reduced outpatient activity, and fewer referrals to cardiac rehabilitation units. OPTIMIZE clinicians at a University hospital's HF clinic in Thailand observed a 16% reduction in the number of outpatient visits and a 22% decline in the number of hospitalizations during the peak of the pandemic, although there were no restrictions on hospitalizations for symptomatic patients; in addition, HF readmission rates were significantly lower than in the pre-COVID period (2.5% vs. 8.7%) [ 16 ]. In countries with high COVID-19 rates and already limited HF services, the reallocation of staff and facilities to care of patients with COVID-19 was particularly problematic.…”

“…The widely reported ‘techceleration’ triggered by the pandemic – with rapid adoption of more digital solutions for healthcare needs – had some benefits for patients with HF. In Thailand, OPTIMIZE coordinators reported that a telemedicine program was found to be effective in achieving target doses of guideline-directed medical therapy [ 16 ]. In Poland, clinicians in the OPTIMIZE network reported that, for those with a cardiac implantable electronic device such as an ICD or CRT, follow-up was largely shifted to remote device checks, with no harmful effect on device safety [ 21 ].…”