Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

Application of telemedicine technology for cardiovascular diseases management during the COVID-19 pandemic: a scoping review

Background

Recently, the use of telemedicine technology has increased due to the Covid-19 pandemic. Cardiovascular diseases management is one of the areas that has benefited from using this technology. This study aimed to identify the applications of telemedicine for cardiovascular diseases management during the Covid-19 pandemic.

Methods

This scoping study was conducted in 2023. Various databases, including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, CINAHL, ProQuest, and IEEE Xplore along with Google Scholar were searched and all related quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the required data were extracted, and the findings were reported narratively.

Results

A total of 17 articles were included in this study. The results showed that teleconsultation via telephone and videoconferencing were the most common used technologies. Telemedicine helped to improve clinical impacts such as patient health status and quality of care, and reduced hospitalizations and re-admission rates compared to in-person visits. The non-clinical impact included reducing waiting time, in-person visits, and healthcare costs during the Covid-19 pandemic.

Conclusion

The Covid-19 pandemic has led to an increased use of telemedicine technology, especially for patients with cardiovascular diseases. As teleconsultation and telemonitoring are useful for cardiovascular diseases management and regular examinations, future research should investigate how these technologies can be improved and used for a wider population.

Cardiology in a Digital Age: Opportunities and Challenges for e-Health: A Literature Review

To date, mortality rates associated with heart diseases are dangerously increasing, making them the leading cause of death globally. From this point of view, digital technologies can provide health systems with the necessary support to increase prevention and monitoring, and improve care delivery. The present study proposes a review of the literature to understand the state of the art and the outcomes of international experiences. A reference framework is defined to develop reflections to optimize the use of resources and technologies, favoring the development of new organizational models and intervention strategies. Findings highlight the potential significance of e-health and telemedicine in supporting novel solutions and organizational models for cardiac illnesses as a response to the requirements and restrictions of patients and health systems. While privacy concerns and technology-acceptance-related issues arise, new avenues for research and clinical practice emerge, with the need to study ad hoc managerial models according to the type of patient and disease.

The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic

COVID-19 pandemic has negatively impacted the management of patients with acute and chronic cardiovascular disease: acute coronary syndrome patients were often not timely reperfused, heart failure patients not adequately followed up and titrated, atrial arrhythmias not efficaciously treated and became chronic. New phenotypes of cardiovascular patients were more and more frequent during COVID-19 pandemic and are expected to be even more frequent in the next future in the new world shaped by the pandemic. We therefore aimed to briefly summarize the main changes in the phenotype of cardiovascular patients in the COVID-19 era, focusing on new clinical challenges and possible therapeutic options.

Reimbursement practices for use of digital devices in atrial fibrillation and other arrhythmias: a European Heart Rhythm Association survey

AIMS

Since digital devices are increasingly used in cardiology for assessing cardiac rhythm and detecting arrhythmias, especially atrial fibrillation (AF), our aim was to evaluate the expectations and opinions of healthcare professionals in Europe on reimbursement policies for the use of digital devices (including wearables) in AF and other arrhythmias.

METHODS AND RESULTS

An anonymous survey was proposed through announcements on the European Heart Rhythm Association website, social media channels, and mail newsletter. Two hundred and seventeen healthcare professionals participated in the survey: 32.7%, reported regular use of digital devices, 45.2% reported that they sometimes use these tools, 18.6% that they do not use but would like to. Only a minority (3.5%) reported a lack of trust in digital devices. The survey highlighted a general propensity to provide medical consultation for suspected AF or other arrhythmias detected by a consumer-initiated use of digital devices, even if time constraints and reimbursement availability emerged as important elements. More than 85% of respondents agreed that reimbursement should be applied for clinical use of digital devices, also in different settings such as post-stroke, post-cardioversion, post-ablation, and in patients with palpitations or syncope. Finally, 73.6% of respondents confirmed a lack of reimbursement fees in their country for physicians' consultations (tracings interpretation) related to digital devices.

CONCLUSIONS

Digital devices, including wearables, are increasingly and widely used for assessing cardiac rhythm and detecting AF, but a definition of reimbursement policies for physicians' consultations is needed.

Current status of reimbursement practices for remote monitoring of cardiac implantable electrical devices across Europe

Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) is currently proposed as a standard of care for CIEDs follow-up, as recommended by major cardiology societies worldwide. By detecting a series of relevant device and patient-related parameters, RM is a valuable option for early detection of CIEDs' technical issues, as well as changes in parameters related to cardio-respiratory functions. Moreover, RM may allow longer spacing between in-office follow-ups and better organization of in-hospital resources. Despite these potential advantages, resulting in improved patient safety, we are still far from a widespread diffusion of RM across Europe. Reimbursement policies across Europe still show an important heterogeneity and have been considered as an important barrier to full implementation of RM as a standard for the follow-up of all the patients with pacemakers, defibrillators, devices for cardiac resynchronization, or implantable loop recorders. Indeed, in many countries, there are still inertia and unresponsiveness to the request for widespread implementation of RM for CIEDs, although an improvement was found in some countries as compared to years ago, related to the provision of some form of reimbursement. As a matter of fact, the COVID-19 pandemic has promoted an increased use of digital health for connecting physicians to patients, even if digital literacy may be a limit for the widespread implementation of telemedicine. CIEDs have the advantage of making possible RM with an already defined organization and reliable systems for data transmissions that can be easily implemented as a standard of care for present and future cardiology practice.

A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic

Telemedicine is making an important contribution to the fight against the COVID-19 pandemic and to supporting the health domain. Its use has registered initial problems with often-patchy practise. The objective of this study was to analyze the launch and deployment of telemedicine in Italy through a narrative review. The narrative review faced two points of view: (a) the first point of view revised the institutional initiatives of the Italian government developed to promote the use of telemedicine; (b) the second point of view reviewed the evolution of scientific literature in the sector, with reference to the Italian situation. In the second point of view, we applied both a standard narrative checklist and an eligibility approach. The first point of view reported an analysis of national documents aimed at promoting, through indications and recommendations, the use of telemedicine. The second point of view analyzed 39 qualified references. The analysis highlighted: (a) that initially, there was a disorientation, followed by reflections that emerged immediately after; (b) a telemedicine application not only in the traditional sectors (e.g., diabetology, cardiology, oncology, neurology) but also in new and fields never explored before; and (c) a high level of acceptance and a desire to continue in the after-pandemic future (which emerged in some studies through dedicated questionnaires). The study offers stimuli for both stakeholders and scholars to improve the use of telemedicine during the pandemic and in the future.

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.

Digital literacy as a potential barrier to implementation of cardiology tele-visits after COVID-19 pandemic: the INFO-COVID survey

BACKGROUND

During the COVID-19 pandemic, the implementation of telemedicine has represented a new potential option for outpatient care. The aim of our study was to evaluate digital literacy among cardiology outpatients.

METHODS

From March to June 2020, a survey on telehealth among cardiology outpatients was performed. Digital literacy was investigated through six main domains: age; sex; educational level; internet access; availability of internet sources; knowledge and use of teleconference software programs.

RESULTS

The study included 1067 patients, median age 70 years, 41.3% females. The majority of the patients (58.0%) had a secondary school degree, but among patients aged ≥ 75 years old the most represented educational level was primary school or none. Overall, for internet access, there was a splitting between "never" (42.1%) and "every day" (41.0%), while only 2.7% answered "at least 1/month" and 14.2% "at least 1/week". In the total population, the most used devices for internet access were smartphones (59.0%), and WhatsApp represented the most used app (57.3%). Internet users were younger compared to non-internet users (63 vs. 78 years old, respectively) and with a higher educational level. Age and educational level were associated with non-use of internet (age-per 10-year increase odds ratio (OR) = 3.07, 95% CI: 2.54-3.71, secondary school OR = 0.18, 95% CI: 0.12-0.26, university OR = 0.05, 95% CI: 0.02-0.10).

CONCLUSIONS

Telemedicine represents an appealing option to implement medical practice, and for its development it is important to address the gaps in patients' digital skills, with age and educational level being key factors in this setting.