ASPC: Telehealth, fast response to CV symptoms crucial during COVID-19 pandemic
During the COVID-19 pandemic, cardiologists can utilize telehealth to reach out to their patients without disruption and should encourage them to get CV symptoms addressed immediately, according to a scientific statement.
The statement by the American Society for Preventive Cardiology (ASPC), published in the American Journal of Preventive Cardiology, also focused on emphasizing the importance of CV health and continued care.
“The COVID-19 pandemic has created several disruptions in outpatient care for patients at higher risk of cardiovascular disease, and we are concerned about future waves of preventable cardiovascular events that will follow,” Amit Khera, MD, MSc, FACC, FAHA, professor of internal medicine at UT Southwestern Medical Center, director of the UT Southwestern Preventive Cardiology Program and president of the ASPC, said in a press release. “Several strategies are available to ensure ongoing care including preventive measures, and we aim to highlight these strategies in this document.”
CVD related to COVID-19
It has been previously reported that among the most common comorbidities in patients with COVID-19 are CVD, hypertension and diabetes. In addition, COVID-19 can affect the CV system including elevations in high-sensitivity cardiac troponin and substantial myocardial injury, according to the scientific statement.
Several professional organizations including the American College of Cardiology and the American Heart Association have recommended continuation of ACE inhibitors and angiotensin receptor blockers in patients with COVID-19, although they do not address whether they should be initiated in the absence of clinical indications including HF, hypertension or diabetes. The ASPC stated it agrees with those recommendations despite a lack of clinical trial data.
The scientific statement emphases the importance of telehealth visits to minimize exposure for health care providers and patients. This can also prevent deferring or delaying care.
“Preventive cardiology practices are the ideal setting for telehealth, as visits are less reliant on in-office testing and a detailed physical examination, but rather more focused on counseling,” Khera and colleagues wrote. “Further, lifestyle interventions require increased visit frequency, which can be facilitated by shorter, regular telehealth visits.”
During telehealth visits, cardiologists should counsel their patients to communicate with them if any cardiac symptoms arise that may cause concern. Patients should not delay care for severe symptoms due to fears related to COVID-19.
Medication access and adherence remain an issue even during a global pandemic. Cardiologists should review these barriers with patients at every contact and recommend strategies to continue a patient’s supply of medications. For example, some local pharmacies offer home delivery and early refill options. Some states have allowed pharmacists to refill some prescriptions if a prescribing provider cannot be contacted.
“The best way to safeguard drug access during times of stress is to guarantee it during times of normalcy,” Khera and colleagues wrote. “When this crisis has receded, we must immediately adopt lessons learned about improving and facilitating medication access and adherence. We must also be prepared for the onslaught of the newly uninsured and financially strapped that will face extensive challenges to access essential affordable medications.”
Team-based care with the entire CV team has become an important way to continue care for these patients, according to the scientific statement. This team can include physicians, advanced practice clinicians, patient navigators, pharmacists and dietitians. The members of this team can also participate in telehealth visits, which can increase opportunities for patient interaction and scheduling flexibility.
Cardiologists and other members of the team can guide patients on how to safely participate in physical activity despite being quarantined. Several options include virtual group exercise classes, a virtual workout partner and step counters. This can also serve as an opportunity to get the family more active
“More time at home represents an opportunity to involve the whole family in exercise, educate children about the importance of regular activity and introduce exercise as part of joyful routines to be maintained once outdoor restrictions have been lifted,” Khera and colleagues wrote.
Nutrition is another important aspect of CV health that should be focused on while in quarantine. Cardiologists can review food access with their patients and provide information on nutritionally dense foods that are also low cost, according to the statement.
Cardiac rehabilitation programs can still continue virtually during this pandemic. Several centers are now implementing telehealth programs, which has not been done often in the past due to a lack of reimbursement, according to the scientific statement.
“With COVID-19, there is a great opportunity to leverage this momentum for reimbursement of home-based cardiac rehabilitation,” Khera and colleagues wrote. “COVID-19 had made abundantly clear to all health care stakeholders (payers, patients, providers, etc) the critical role and effectiveness of telehealth.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio. – by Darlene Dobkowski
Disclosures: Khera reports no relevant financial disclosures. Please see the scientific statement for all other authors’ relevant financial disclosures.