The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure

• DOI: 10.1371/journal.pone.0249043
• Publication Date: 2021-03-23T17:35:47Z
• Authors: Sarinya Puwanant; Supanee Sinphurms...; Laddawan Krailak; Pavinee Nakaviroj; Noppawan Boonbumrong; Sarawut Siwamogsa...; Krailerk Chettaku...; Aekarach Ariyacha...; Smonporn Boonyara...
• Keywords: Adult; Male; Ejection fraction; Databases, Factual; Science; Mechanical Circulatory Support Systems; Biomedical Engineering; Cardiology; Heart failure; Infectious disease (medical specialty); Heart transplantation; FOS: Medical engineering; Ambulatory Care Facilities; Patient Readmission; Severity of Illness Index; 03 medical and health sciences; Engineering; 0302 clinical medicine; Diagnosis and Treatment of Heart Failure; Health Sciences; Neurological Manifestations of COVID-19 Infection; Ambulatory; Humans; Disease; Internal medicine; Aged; Heart Failure; Pandemic; SARS-CoV-2; Q; R; COVID-19; Middle Aged; 3. Good health; Hospitalization; Survival Rate; Coronavirus disease 2019 (COVID-19); Neurology; Cardiovascular Diseases; Physical Sciences; Heart Transplantation; Medicine; Emergency medicine; Female; Cardiology and Cardiovascular Medicine; Research Article

Background We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic.

Methods Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit.

Results Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group.

Conclusions HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.