Impact of telemedicine on the management of heart failure patients during coronavirus disease 2019 pandemic

Abstract

Aims: Chronic heart failure (HF) is a major comorbidity accounting for an increased severity and mortality related to coronavirus disease 2019 (COVID-19). To reduce the risk of COVID-19 in HF patients, telemedicine has been encouraged. Methods and results: During the COVID-19 pandemic, telemedical management with mainly over-the-phone appointments became a major strategy of follow-up of our HF clinic patients. Previously, the large majority of patients have been seen in the hospital with direct patient-provider contact. We compared both strategies of follow-up, in pre-pandemic (PPP) and pandemic (PP) periods, regarding total mortality and hospitalizations/emergency department (ED) visits due to HF exacerbation. We prospectively studied a cohort of 196 patients. The mean follow-up time in PPP was 1.4 years. In this period, 20 patients died. In PP (follow-up of 71 days), there was one additional death. Total mortality in the first year of follow-up was 12.0%, matching the mortality predicted by the Meta-Analysis Global Group in Chronic Heart Failure score. Considering hospitalizations/ED visits due to decompensated HF, there was no statistically significant difference between PPP and PP. Only one patient was diagnosed with COVID-19. Conclusions: In the light of an increase in telemedical management of this cohort of HF patients, we were able to maintain a low rate of admissions due to HF decompensation, without an increment in mortality. Regarding these results, we encourage the incremental use of telemedicine in HF patients in the context of this or future pandemics and also in situations in which physical consultation might not be possible due to logistic issues.