The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure
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
DOI:
10.1371/journal.pone.0249043
Publication Date:
2021-03-23T17:35:47Z
AUTHORS (9)
ABSTRACT
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.
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