Impact of the COVID 19 pandemic on the outpatient management of patients with heart failure: From scheduled outpatient clinics to telemedicine

ABSTRACT

With the advent of the COVID19 pandemic, all patients in our heart failure clinic (HFC) were assessed by telephone instead of the scheduled visit, thus showing the need for an additional remote monitoring system. Telecardiology (TC) is already a well-established practice in our clinic in patients with devices. From a joint collaboration project of APSS, FBK and Trentino salute 4.0, an APP was developed, available on the Play Store TreC Cardiologia. The project started with Beta Test on 29 June 2020. The APP was initially given to patients already followed by the TC clinic and subsequently to those followed by the HFC or discharged with a diagnosis of heart failure (HF) . The APP allows you to 1) monitor the progress of some customizable clinical parameters;2) interface with our clinic via chat to send text messages to communicate any symptoms and send photographic material;3) perform scheduled or on-demand video calls;4) view the therapy;5) set reminders for the patient on certain actions to be performed, fill forms about his health conditions;6) in the future, patients will be able to access educational material on their pathology. The project also includes a dedicated nurse who takes care of the management of the patient with APP from administration onwards, favoring his empowerment, reporting elements of destabilization to the referring doctor with subsequent decisions (video call, in-office visit, hospitalization). As of 31/12/2020 the APP was given to 66 patients. Since March 2020, HFC patients are still followed up with a phone call and/or an in-office visit, according to clinical trend. The use of the APP and the collection of data relating to efficacy and criticality have begun.The use of additional instrumentation to be provided to the patient is being evaluated. The literature that emerged from the COVID19 pandemic has confirmed the role of telemedicine in optimizing management at home in patients with HF. The new readily available technologies (e.g. smartphone with the possibility of video call) also allow you to maintain eye contact with the patient, taking on both clinical and psychological value, highlighting destabilization in time and also being reassuring about the pandemic. The epidemiology of HF and the ongoing pandemic suggest that technology will have to increasingly support the management of these patients.