ABSTRACT
Background: During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, pediatric heart centers were forced to rapidly alter the way patient care was provided in order to minimize interruption to patient care as well as exposure to the virus. In this study, we used a survey-based approach to characterize the changes that occurred in pediatric cardiology practices across the country during and just following the initial peak of COVID-19. Methods: In this survey based descriptive study we characterize changes that occurred within pediatric cardiology practices across the United States and describe provider experience and attitudes towards these changes during the pandemic. decision making during this period. This survey was emailed to an existing list serve of American Academy of Pediatrics Section on Cardiology and Cardiothoracic Surgery (AAP:SOCCS) members. Recipients of the survey included pediatric cardiologists, cardiothoracic surgeons, and fellows-intraining. The questionnaire was initially distributed in June 2020 and was active through August 2020. Results: Surveys were returned by 79 participants across 28 states. Areas of practice of respondents included general cardiology, non-invasive imaging, electrophysiology, heart failure/transplant, interventional cardiology, and adults with congenital heart disease. Common changes that were implemented included decreased numbers of procedures, limiting visitors, and shifting towards telemedicine encounters. There was a high level of satisfaction among providers with telemedicine encounters and a variety of platforms were utilized. Echocardiography was less likely to be performed during the pandemic as compared to prior to the pandemic in nearly all clinical scenarios presented. More than half of respondents expressed concerns about financial stability with regards to personal or practice situation but most were not frequently concerned about their personal safety. Conclusion: Pediatric cardiology practice across the country was heavily impacted by COVID-19 and required many adaptations including minimization of non-essential procedures and increasing use of telemedicine. Providers were generally satisfied with telemedicine and utilized several platforms. Financial concerns were common;however, most participants were not frequently concerned about personal safety. Inter-institutional collaboration could be useful in creating standardized protocols based on shared experiences that could be rapidly implemented in future public health crises. Experience with Telemedicine. A) Barriers to implementing telemedicine. B) Provider rated effectiveness of telemedicine. C) Home monitoring devices used as part of telemedicine program. D) Provider satisfaction vs perceived patient satisfaction with telemedicine encounters. Likelihood of Performing Echocardiography Prior to and During COVID-19 Pandemic. Participants were asked to rate the likelihood for each scenario as always, frequently, occasionally, or never. Responses were converted to a 5-point scale. Pre- and post- responses were analyzed using Wilcoxon signed-rank test. Significant decreases in likelihood of echocardiography were found in nearly all situations.
ABSTRACT
Background: Cardiac injury associated with multi-system inflammatory syndrome in children (MIS-C) has been extensively reported but the impact of cardiac injury in children with SARSCoV-2 infection in the absence of MIS-C has not been well described. In this study we describe the cardiac involvement found in children with positive SARS-CoV-2 PCR tests and evaluate the association of cardiac injury with severe outcome in this population. Methods: A retrospective chart review of all patients ages 0-21 presenting to the emergency department or admitted at our institution during and just beyond the peak of the COVID-19 pandemic at our institution was performed. We excluded patients with MIS-C, cardiomyopathy, or complex congenital heart disease. Cardiac injury was defined as elevated high sensitivity troponin and/or N-terminal pro-brain type natriuretic peptide above 99th percentile. Severe illness was defined as need for advanced respiratory support (positive pressure or mechanical ventilation above baseline), inotropic or vasopressor support, and/or death from any cause during admission. Results: During the study period there were 103 patients with positive SARS-CoV-2 PCR, 17 of whom were excluded for MIS-C, 4 of whom were excluded for cardiomyopathy, 2 for complex congenital heart disease including one with repaired Taussig-Bing anomaly and one with double outlet right ventricle who underwent Fontan surgery. Of the 80/103 (78%) patients remaining in the analysis, 31/80 (39%) were female and the median age was 12.5 years (IWR 1.9-17.5). High-sensitivity troponin T and/or NT-proBNP were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities such as lung disease, diabetes, or genetic syndromes. Severe outcome occurred in 14/27 (52%) patients and 5/5 (100%) of those with cardiac injury as compared to 9/22 (41%) patients without cardiac injury (p<0.05). Advanced respiratory support was more common in those with cardiac injury as compared to those without, occurring in 5/5 (100%) patients with cardiac injury and in 8/22 (36%) patients without cardiac injury (p<0.05). Electrocardiographic abnormalities were identified in 14/38 (37%) studies and no left ventricular dysfunction was identified on echocardiography. Conclusion: During the initial peak of the pandemic at our institution, cardiac injury was present in 19% of those for whom high-sensitivity troponin and/or NT-proBNP were measured. Presence of cardiac injury was associated with greater risk of severe outcomes including advanced respiratory support. Larger studies to determine the true incidence of cardiac injury in children with COVID-19 would be useful to guide recommendations for standard workup and management.