Frontline connect: Evaluating a virtual technology program to enhance patient and provider communication during COVID-19.

RATIONALE: Since the beginning of the COVID-19 pandemic, many hospitals have reduced in-hospital visitation. In these situations, virtual communication tools have helped maintain interaction between parties. The Frontline Connect program was designed to address communication and patient care challenges by providing data-enabled devices to clinical staff in hospitals. OBJECTIVE: This study aimed to identify areas of improvement for the Frontline Connect program by: (a) evaluating communication needs, user experience, and program satisfaction; and (b) identifying potential barriers to device access or use. METHODS: We administered pre-implementation needs assessment, post-use, and exit surveys to healthcare staff at a pilot hospital site in Ontario. Recruitment was through email lists and site champions using convenience sampling. We descriptively analysed survey responses and compared the initial need statements to post-implementation use-cases identified by users. RESULTS: We received 139 needs assessments, 31 user experience assessments, and 47 exit survey responses. Most device use occurred in the emergency department and intensive care units and was facilitated by social workers, nurses, and physicians to connect patients, families, and care providers. Pre-implementation concerns were related to infection control, data security, and device privacy. In the exit survey, these were replaced by other concerns including Internet connectivity and time-intensiveness. Device utility and ease-of-use were rated 9.7/10 and 9.6/10 respectively in the user experience survey, though overall experience was rated 7.2/10 in the exit survey. Overall, respondents viewed the devices as useful and we agree with participants who suggested increased program promotion and training would likely improve adoption. CONCLUSIONS: We found that our virtual technology program for facilitating communication was positively perceived. Survey feedback indicates that a rapid rollout in response to urgent pandemic-related needs was feasible, though program logistics could be improved. The current work supports the need to improve, standardize, and sustain virtual communication programs in hospitals.

Ventricular rate determines early bradycardic electrical remodeling.

OBJECTIVES: The purpose of this study was to isolate chronic ventricular rate as the primary determinant of early bradycardic ventricular electrical remodeling. BACKGROUND: Ventricular repolarization delay predisposing to potentially lethal tachydysrhythmias occurs during chronic bradycardia. Prolonged QT intervals and torsades de pointes are associated with down-regulated ventricular myocyte delayed rectifier potassium (K(+)) currents. METHODS: Transcatheter AV node ablation in rabbits was followed by chronic right ventricular pacing at either 140 bpm (n = 16) or the near-physiologic rate of 280 bpm (n = 9). ECG QT intervals were assessed in vivo at days 0 and 8 of paced AV block. Repolarizing currents in isolated left and right ventricular myocytes were assessed using whole-cell patch clamp technique. RESULTS: Bradycardic rabbits had increased steady-state QT intervals (230 +/- 6 ms vs 206 +/- 7 ms [mean +/- SE], day 8 vs day 0; P < .001). Biventricular myocyte expression of the delayed rectifier K(+) currents I(Kr) and I(Ks) was down-regulated in bradycardic rabbits, with no change in the transient outward current I(to) or inwardly rectifying current I(K1). None of these changes were observed in rabbits paced at 280 bpm. Pause-dependent torsades de pointes was documented in one bradycardic animal on day 8. No heart failure or ventricular hypertrophy was apparent. CONCLUSIONS: Bradycardic ventricular electrical remodeling proceeds independently of structural remodeling, heart failure, or AV synchrony and is prevented by maintenance of near-physiologic ventricular rate.

A novel rabbit model of variably compensated complete heart block.

Complete heart block (CHB) provides a useful substrate for study of bradycardia-dependent ventricular arrhythmias and cardiac function. Existing CHB animal models are limited by surgical recovery time and reliance on intrinsic escape rhythms. We describe a novel closed-chest rabbit model of CHB involving transcatheter radiofrequency (RF) atrioventricular (AV) node ablation and ventricular rate control with chronic transvenous pacing. Permanent CHB was achieved in 34 of 38 attempts overall. Procedural mortality due to cardiac tamponade (n = 2), airway complications (n = 2), and unknown causes (n = 5) occurred in nine animals. Survivors with CHB (n = 28) were maintained for < or = 22 days, during which there were three late deaths related to infection (n = 1) or respiratory distress (n = 2). None of the survivors with CHB showed recovery of AV conduction or pacemaker capture loss during chronic ventricular pacing at about one-half normal sinus rates, and 25 animals surviving to death showed no overt signs of hemodynamic compromise such as lethargy, poor feeding, or respiratory distress. This approach provides a reproducible nonsurgical CHB model with adjustable ventricular rate control.