Clinical Support through Telemedicine in Heart Failure Outpatients during the COVID-19 Pandemic Period: Results of a 12-Months Follow Up

Background: Heart failure (HF) patients are predisposed to recurrences and disease destabilizations, especially during the COVID-19 outbreak period. In this scenario, telemedicine could be a proper way to ensure continuous care. The purpose of the study was to compare two modalities of HF outpatients’ follow up, the traditional in-person visits and telephone consultations, during the COVID-19 pandemic period in Italy. Methods: We conducted an observational study on consecutive HF outpatients. The follow up period was 12 months, starting from the beginning of the COVID-19 Italy lockdown. According to the follow up modality, and after the propensity matching score, patients were divided into two groups: those in G1 (n = 92) were managed with traditional in-person visits and those in G2 (n = 92) were managed with telephone consultation. Major adverse cardiovascular events (MACE) were the primary endpoints. Secondary endpoints were overall mortality, cardiovascular death, cardiovascular hospitalization, and hospitalization due to HF. Results: No significant differences between G1 and G2 have been observed regarding MACE (p = 0.65), cardiovascular death (p = 0.39), overall mortality (p = 0.85), hospitalization due to acute HF (p = 0.07), and cardiovascular hospitalization (p = 0.4). Survival analysis performed by the Kaplan–Meier method also did not show significant differences between G1 and G2. Conclusions: Telephone consultations represented a valid option to manage HF outpatients during COVID-19 pandemic, comparable to traditional in-person visits.

[1]  A. Fiorentino,et al.  A Multistep Approach to Deal With Advanced Heart Failure: A Case Report on the Positive Effect of Cardiac Contractility Modulation Therapy on Pulmonary Pressure Measured by CardioMEMS , 2022, Frontiers in Cardiovascular Medicine.

[2]  F. Fedele,et al.  Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity? , 2022, Journal of clinical medicine.

[3]  M. Wawrzyńska,et al.  Telemedicine in Cardiology: Modern Technologies to Improve Cardiovascular Patients’ Outcomes—A Narrative Review , 2022, Medicina.

[4]  J. McMurray,et al.  2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure , 2022, European journal of heart failure.

[5]  A. Budaj,et al.  Impact of COVID‐19 pandemic on acute heart failure admissions and mortality: a multicentre study (COV‐HF‐SIRIO 6 study) , 2021, ESC heart failure.

[6]  F. Fedele,et al.  Sodium-glucose cotransporter 2 inhibitors and heart failure: the best timing for the right patient , 2021, Heart Failure Reviews.

[7]  J. Spertus,et al.  Outpatient Management of Heart Failure During the COVID-19 Pandemic After Adoption of a Telehealth Model , 2021, JACC: Heart Failure.

[8]  F. Fedele,et al.  Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets , 2021, International journal of molecular sciences.

[9]  C. Lavalle,et al.  Home delivery of the communicator for remote monitoring of cardiac implantable devices: A multicenter experience during the covid‐19 lockdown , 2021, Pacing and clinical electrophysiology : PACE.

[10]  Sara Simões Dias,et al.  Impact of telemedicine on the management of heart failure patients during coronavirus disease 2019 pandemic , 2021, ESC heart failure.

[11]  Harleah G. Buck,et al.  Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients. , 2021, Journal of pain and symptom management.

[12]  Kristen M. Tecson,et al.  Screening, detection, and management of heart failure in the SARS-CoV2 (COVID-19) pandemic , 2021, Heart Failure Reviews.

[13]  M. Ciccarelli,et al.  Artificial Intelligence as a Business Partner in Cardiovascular Precision Medicine: an Emerging Approach for Disease Detection and Treatment Optimization. , 2020, Current medicinal chemistry.

[14]  F. Fedele,et al.  Reduction in heart failure hospitalization rate during coronavirus disease 19 pandemic outbreak , 2020, ESC heart failure.

[15]  C. Cunnington,et al.  The impact of COVID‐19 on the management of heart failure: a United Kingdom patient questionnaire study , 2020, medRxiv.

[16]  C. Gale,et al.  Place and causes of acute cardiovascular mortality during the COVID-19 pandemic , 2020, Heart.

[17]  F. Fedele,et al.  Management of cardiac implantable electronic device follow‐up in COVID‐19 pandemic: Lessons learned during Italian lockdown , 2020, Journal of cardiovascular electrophysiology.

[18]  G. Hindricks,et al.  Emergency hospital admissions and interventional treatments for heart failure and cardiac arrhythmias in Germany during the Covid-19 outbreak Insights from the German-wide Helios hospital network , 2020, European heart journal. Quality of care & clinical outcomes.

[19]  C. Torp‐Pedersen,et al.  Incidence of New-Onset and Worsening Heart Failure Before and After the COVID-19 Epidemic Lockdown in Denmark , 2020, Circulation. Heart failure.

[20]  R. D'Assante,et al.  Heart failure management during the COVID‐19 outbreak in Italy: a telemedicine experience from a heart failure university tertiary referral centre , 2020, European journal of heart failure.

[21]  P. Ponikowski,et al.  Management of heart failure patients with COVID‐19: a joint position paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology , 2020, European journal of heart failure.

[22]  J. Ruidavets,et al.  Telemonitoring versus standard care in heart failure: a randomised multicentre trial , 2020, European journal of heart failure.

[23]  Furio Colivicchi,et al.  The Impact of the Coronavirus Disease-2019 Pandemic and Italian Lockdown Measures on Clinical Presentation and Management of Acute Heart Failure , 2020, Journal of Cardiac Failure.

[24]  Michael E. Hall,et al.  Reductions in Heart Failure Hospitalizations During the COVID-19 Pandemic , 2020, Journal of Cardiac Failure.

[25]  E. Gronda,et al.  Noncardiac comorbidity clustering in heart failure: an overlooked aspect with potential therapeutic door , 2020, Heart Failure Reviews.

[26]  R. Clark,et al.  Caring for people with heart failure and many other medical problems through and beyond the COVID‐19 pandemic: the advantages of universal access to home telemonitoring , 2020, European journal of heart failure.

[27]  C. Napoli,et al.  A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors , 2020, International journal of environmental research and public health.

[28]  N. Reza,et al.  Secondary Impact of the COVID-19 Pandemic on Patients With Heart Failure , 2020, Circulation. Heart failure.

[29]  Hongliang Li,et al.  The Science Underlying COVID-19: Implications for the Cardiovascular System. , 2020, Circulation.

[30]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[31]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[32]  M. B. Jensen,et al.  Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial , 2020, BMJ Open.

[33]  Saravana Kumar,et al.  Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health , 2019, PloS one.

[34]  S. Ghio,et al.  Early readmission for heart failure: An avoidable or ineluctable debacle? , 2019, International journal of cardiology.

[35]  C. Ahn,et al.  Smart Care Based on Telemonitoring and Telemedicine for Type 2 Diabetes Care: Multi-Center Randomized Controlled Trial. , 2018, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[36]  N. Albert,et al.  Factors Associated With Adherence to 14-Day Office Appointments After Heart Failure Discharge. , 2017, Journal of cardiac failure.

[37]  Shannon M. Dunlay,et al.  Epidemiology of heart failure with preserved ejection fraction , 2017, Nature Reviews Cardiology.

[38]  Hai-Feng Zhang,et al.  Clinical effectiveness of telemedicine for chronic heart failure: a systematic review and meta-analysis , 2017, Journal of Investigative Medicine.

[39]  J. Portnoy,et al.  Telemedicine is as effective as in-person visits for patients with asthma. , 2016, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[40]  Deepak L. Bhatt,et al.  Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure , 2016, Circulation: Heart Failure.

[41]  Karl Swedberg,et al.  Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. , 2013, European heart journal.

[42]  G. Fonarow,et al.  Home monitoring for heart failure management. , 2012, Journal of the American College of Cardiology.

[43]  C. Ng,et al.  Why Do Patients With Chronic Illnesses Fail To Keep Their Appointments? A Telephone Interview , 2006, Asia-Pacific journal of public health.