Technology and cardiovascular diseases in the era of COVID‐19

Abstract

The global coronavirus disease 2019 (COVID-19) pandemic has had unprecedented effects on healthcare systems worldwide. Hospitals have been under intense strain as a result of the surge in COVID-19 cases, and there has been a stark reduction in the inpatient provision of cardiovascular care.1 An alternative to inpatient service provision is increased use of digital healthcare tools.2 The rapid advancements in technology and the rise in popularity of mobile devices in recent years meant that telemedicine is an increasingly viable option.3 The Guidance from the National Health Service in the United Kingdom supports the use of digital consultations where possible to reduce the number of in-person appointments in an attempt to reduce the risk of COVID-19 spread and care provision for those who need to be under regular follow-up.4 The utilization of digital technology and telemedicine in healthcare can come in different forms including but not limited to telephone and video consultations.3 These tools can be used not only to follow-up cases but also to diagnose new conditions in patients through direct patient interaction over video consultation and assessment. While primary care has incorporated telemedicine into clinical practice in recent times with regular telephone consultations and home monitoring of patients, this may be slightly more difficult when used for patients with cardiovascular disease due to increased complexity.5 However, due to the current COVID-19 pandemic and the resultant strain on healthcare systems worldwide, innovative solutions are needed in all aspects of patient care including in secondary and tertiary care. Patients with cardiovascular disease can benefit from the application of telemedicine in the form of remote consultations, monitoring of clinical parameters, and remote diagnostic investigations. A randomized controlled trial evaluating the effectiveness of telephone consultations for patients with heart failure found that there were no significant differences in the rate of hospitalizations, readmission rate, or mortality between patients managed using the telephone approach or usual face-to-face care.6 Similarly, the home or hospital in heart failure study, a multinational randomized controlled trial assessing the feasibility of home telemonitoring (HT) of clinical parameters in decreasing cardiac events, found that HT is feasible and has high compliance among patients, and can potentially reduce clinical instability.7 Another potential use of telemedicine in cardiovascular care is the remote provision of cardiac rehabilitation, which includes patient education and supervised exercise delivered by telephone or video conferencing, and this approach can be highly effective.8 Telemedicine can also be utilized in the “forward triage” of patients, using smartphone devices or computers to screen patients before they arrive at the emergency department. This is of particular importance given the current COVID-19 pandemic, as patients with high-risk features for the virus can be isolated quicker upon arrival, therefore minimizing exposure to other patients and staff.9 As patients with cardiovascular diseases that are requiring surgery are at a higher risk of contracting the COVID-19 infection, with higher morbidity and mortality than the general population,10 telemedicine and digital healthcare can play a valuable role in their preoperative and postoperative care; in addition to long-term follow-up and possibly reducing the time needed to be spent at hospital amidst the pandemic. Preoperatively, it is possible to triage patients and conduct preoperative assessments and investigations remotely.11 Echocardiograms can be analyzed remotely during real-time consultations to triage cardiac surgery patients,12 and arrhythmias can be detected by utilizing a smartwatch or remote devices.13 In addition, teleconsultations of angiograms have proven successful in diagnosing and referring patients for procedures, includin