Virtual multidisciplinary care for heart failure patients with cardiac resynchronization therapy devices during the
Megan Zhao1, Dingxin Qin1, Gulio Cataldo1
1Cardiovascular Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
Insights
Virtual multidisciplinary care for heart failure (HF) patients with cardiac resynchronization therapy (CRT) devices proved feasible and safe during the COVID-19 pandemic. This approach maintained patient satisfaction without increasing adverse events, supporting digital health adoption.
Area of Science:
- Cardiology
- Digital Health
- Public Health
Background:
- Heart failure (HF) patients with cardiac resynchronization therapy (CRT) devices are a vulnerable population during the COVID-19 pandemic.
- Minimizing SARS-CoV-2 exposure while delivering multidisciplinary care is crucial for these patients.
- Innovative virtual care models are needed to address these challenges.
Purpose of the Study:
- To describe the assessment and management of HF patients with CRT devices in a virtual multidisciplinary clinic during the COVID-19 pandemic.
- To compare clinical outcomes of patients managed virtually versus those in a historical in-person clinic.
- To evaluate patient satisfaction with virtual care.
Main Methods:
- Retrospective cohort study comparing a virtual visit group (N=43) with a historical in-person visit group (N=39).
- Patients with CRT implants were followed for clinical events until July 1st of their respective years (2020 for virtual, 2019 for in-person).
- Primary outcome: composite of all-cause mortality and HF/device-related hospitalizations. Secondary outcomes: patient satisfaction, COVID-19 infection, cardiovascular events.
Main Results:
- 100% of surveyed patients were satisfied with virtual care and willing to use telemedicine again.
- No significant increase in mortality or major cardiovascular events was observed in the virtual visit group compared to the in-person group (2.3% vs. 5.1%, P=0.60).
- One patient in the virtual group died from pneumonia of unclear etiology; no patients were hospitalized for HF/arrhythmia or diagnosed with COVID-19.
Conclusions:
- Virtual multidisciplinary care is a feasible and effective model for managing HF patients with CRT devices.
- This approach achieves high patient satisfaction and does not increase short-term adverse events during a pandemic.
- Virtual care facilitates the adoption of digital health strategies for high-risk cardiac patients.
Background:
Heart failure (HF) patients with CRT devices are a vulnerable patient population during the Coronavirus Disease 2019 (COVID-19) Pandemic. It is important to develop innovative virtual care models to deliver multidisciplinary care while minimizing the risk of SARS-CoV2 exposure.
Objective:
We aim to provide a description of how HF patients with CRT devices were assessed and managed in our virtual multidisciplinary clinic during the COVID-19 Pandemic. Clinical outcomes between this group of patients seen in virtual clinic and a historical cohort followed by in-person multi-disciplinary clinic prior to the pandemic were compared.
Method:
This is a retrospective cohort study of HF patients with CRT implants who were seen in the virtual multidisciplinary clinic from March 18th, 2020 to May 27th, 2020 (Virtual Visit Group, N = 43). A historical cohort of HF patients with CRT devices seen in the ReACT clinic in person during the same calendar time period in 2019 was used as a control group (In-Person Visit Group, N = 39). Both groups were followed until July 1st of the same calendar year (2020 or 2019) for clinical events. The primary outcome measure was a combined outcome of all-cause mortality and HF- or device-related hospitalizations during follow-up. The secondary outcome measures included patient satisfaction, COVID-19 infection, and other cardiovascular events.
Results:
In the Virtual-Visit Group, 21 patients (48.8%) had their initial ReACT clinic visit (first visit after CRT implant) as a virtual visit; 22 patients (51.2%) had prior in-person ReACT clinic visits before the first virtual visit. During the virtual visits, 12 patients had either potential cardiac symptoms or significant device interrogation findings that required clinical intervention. In post-virtual clinic patient satisfaction survey, all 22 patients surveyed (100%) reported being very satisfied or satisfied with the overall experience of the virtual clinic, and every patient (100%) said they would like to use telemedicine again. During a median follow-up period of 82 days (interquartile range [IQR] 61-96 days), one patient died from pneumonia of unclear etiology at an outside hospital, without documentation of COVID-19 positivity. No patient was hospitalized for HF- or arrhythmia-related complications. No patient was diagnosed with COVID-19. Compared with the In-Person Visit Group, there was no significant increase in mortality or major cardiovascular events in the Virtual-Visit Group (2.3% versus 5.1%, P = 0.60).
Conclusions And Relevance:
Virtual multidisciplinary care was feasible for HF patients with cardiac resynchronization therapy devices and achieved good patient satisfaction. Virtual care was not associated with short-term increase in adverse events for HF patients with CRT device during the COVID-19 Pandemic. This virtual care model could help promote the adoption of digital health methodology for high-risk patients with multiple cardiac comorbidities.
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