Virtual anticoagulation clinic -A telehealth model to deliver anticoagulation care during COVID-19 pandemic: Does it work? (Preprint)

Abstract

BACKGROUND COVID -19 pandemic is a disaster. Nationwide lockdown imposed during this pandemic rendered healthcare inaccessible to several patients. Telehealth is a potential alternative utilizing a virtual platform to deliver health care. Patients taking Vitamin K antagonists (VKAs) need continuity of care to achieve and maintain optimal anticoagulation. Moreover, significant numbers of patients taking VKAs have multiple comorbidities making them susceptible to severe COVID-19 infection. Virtual anticoagulation clinic (VAC) was launched to ensure uninterrupted care with reduced exposure of these patients to COVID-19. OBJECTIVE We aimed to study the impact of newly launched Virtual anticoagulation clinic on the quality of anticoagulation and patient satisfaction. METHODS Prospective observational study was conducted on patients enrolled in to the VAC. Out of 356 patients receiving dedicated Anticoagulation clinic care at JSS Hospital, Mysore 128 patients consented to receive anticoagulation care virtually. Digital platforms like WhatsApp, email and voice call/ SMS were used. Patients were monitored for anticoagulation related parameters like TTR, PINRR and adverse events. Patient satisfaction questionnaire (5-point Likert scale) was administered at the end of 3 months. RESULTS Mean age was 55.62 ± 13.77 years with 57% men. Hypertension (55.5%) and diabetes (38.3%) were the most common comorbidities. Atrial fibrillation (61%) was the most common indication. Mean TTR was 75.4± 8.9 %. PINRR was 66.7± 9.47%. 1.8% of INRs were in extreme range. WhatsApp (73%), email (19%) was the most common digital platform used. Voice call and SMS was used by 8% of patients. 74% were extremely satisfied with overall VAC care and 82% of patients were extremely satisfied to continue virtual care as assessed by 5-point Likert scale questionnaire. CONCLUSIONS During the current COVID pandemic, Virtual anticoagulation clinic through digital technology platform was able to provide a satisfactory care to the patients who were on chronic VKA therapy over a short term. CLINICALTRIAL JSSMC/ IEC/ 090620 /01 NCT /2020-21