Thirty-Day Cardiovascular Readmissions Following Discharge with COVID-19: A US Nationwide Readmission Database Analysis from the Pandemic Year 2020.

BACKGROUND: COVID-19 is known to be associated with a myriad of cardiovascular (CV) complications during acute illness, but the rates of readmissions for CV complications after COVID-19 infection are less well established. METHODS: The U.S Nationwide Readmission Database was utilized to identify COVID-19 admissions from April 1st to November 30th, 2020 using ICD-10-CM administrative claims. RESULTS: A total of 521,351 admissions for COVID-19 were identified. The all-cause 30-day readmission rate was 11.6% (n=60,262). The incidence of CV readmissions was 5.1% (n=26,725), accounting for 44.3% of all-cause 30-day readmissions. Both CV and non-CV readmissions occurred at a median of 7 days. Patients readmitted with CV causes had a higher comorbidity burden with Charlson comorbidity median score of 6. The most common CV cause of readmission was acute heart failure (HF) (8.5%) followed by acute myocardial infarction (MI) (5.2%). Venous thromboembolism and stroke during 30-day readmission occurred at a rate of 4.6% and 3.6%, respectively. Stress cardiomyopathy and acute myocarditis were less frequent with an incidence of 0.1% and 0.2%, respectively. CV readmissions were associated with higher mortality compared with non-CV readmissions (16.5% vs. 7.5%, p<0.01). Each 30-day CV readmission was associated with greater cost of care than each non-CV readmission ($13,803 vs. $10,310, p=<0.01). CONCLUSIONS: Among survivors of index COVID-19 admission, 44.7% of all 30-day readmissions were attributed to CV causes. Acute HF remains the most common cause of readmission after COVID-19, followed closely by acute MI. CV causes of readmissions remain a significant source of mortality, morbidity, and resource utilization.

An Analysis of Telehealth in the Outpatient Management of Atrial Fibrillation During the COVID-19 Pandemic.

The COVID-19 pandemic accelerated adaption of a telehealth care model. We studied the impact of telehealth on the management of atrial fibrillation (AF) by electrophysiology providers in a large, multisite clinic. Clinical outcomes, quality metrics, and indicators of clinical activity for patients with AF during the 10-week period of March 22, 2020 to May 30, 2020 were compared with those from the 10-week period of March 24, 2019 to June 1, 2019. There were 1946 unique patient visits for AF (1,040 in 2020 and 906 in 2019). During 120 days after each encounter, there was no difference in hospital admissions (11.7% vs 13.5%, p = 0.25) or emergency department visits (10.4% vs 12.5%, p = 0.15) in 2020 compared with 2019. There was a total of 31 deaths within 120 days, with similar rates in 2020 and 2019 (1.8% vs 1.3%, p = 0.38). There was no significant difference in quality metrics. The following clinical activities occurred less frequently in 2020 than in 2019: offering escalation of rhythm control (16.3% vs 23.3%, p <0.001), ambulatory monitoring (29.7% vs 51.7%, p <0.001), and electrocardiogram review for patients on antiarrhythmic drug therapy (22.1% vs 90.2%, p <0.001). Discussions about risk factor modification were more frequent in 2020 compared with 2019 (87.9% vs 74.8%, p <0.001). In conclusion, the use of telehealth in the outpatient management of AF was associated with similar clinical outcomes and quality metrics but differences in clinical activity compared with traditional ambulatory encounters. Longer-term outcomes warrant further investigation.

Outpatient Management of Heart Failure During the COVID-19 Pandemic After Adoption of a Telehealth Model.

OBJECTIVES: This study sought to determine whether the increased use of telehealth was associated with a difference in outcomes for outpatients with heart failure. BACKGROUND: The COVID-19 pandemic led to dramatic changes in the delivery of outpatient care. It is unclear whether increased use of telehealth affected outcomes for outpatients with heart failure. METHODS: In March 2020, a large Midwestern health care system, encompassing 16 cardiology clinics, 16 emergency departments, and 12 hospitals, initiated a telehealth-based model for outpatient care in the setting of the COVID-19 pandemic. A propensity-matched analysis was performed to compare outcomes between outpatients seen in-person in 2018 and 2019 and via telemedicine in 2020. RESULTS: Among 8,263 unique patients with heart failure with 15,421 clinic visits seen from March 15 to June 15, telehealth was employed in 88.5% of 2020 visits but in none in 2018 or 2019. Despite the pandemic, more outpatients were seen in 2020 (n = 5,224) versus 2018 and 2019 (n = 5,099 per year). Using propensity matching, 4,541 telehealth visits in 2020 were compared with 4,541 in-person visits in 2018 and 2019, and groups were well matched. Mortality was similar for telehealth and in-person visits at both 30 days (0.8% vs 0.7%) and 90 days (2.9% vs 2.4%). Likewise, there was no excess in hospital encounters or need for intensive care with telehealth visits. CONCLUSIONS: A telehealth model for outpatients with heart failure allowed for distanced encounters without increases in subsequent acute care or mortality. As the pressures of the COVID-19 pandemic abate, these data suggest that telehealth outpatient visits in patients with heart failure can be safely incorporated into clinical practice.