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Hayavi-haghighi MH, Gharibzade A, Choobin N, Ansarifard H. Applications and outcomes of implementing telemedicine for hypertension management in COVID-19 pandemic: A systematic review. PLoS One 2024; 19:e0306347. [PMID: 39088489 PMCID: PMC11293715 DOI: 10.1371/journal.pone.0306347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/13/2024] [Indexed: 08/03/2024] Open
Abstract
INTRODUCTION COVID-19 presented a significant challenge for patients with hypertension in terms of access to care. However, telemedicine offered the healthcare system opportunities that had previously been underutilized. Therefore, this study aims to systematically review the applications and outcomes of telemedicine for hypertension management during the COVID-19 pandemic. METHOD A structured search was conducted in accordance with PRISMA guidelines across multiple databases, including PubMed, Cochrane, Web of Science, and Scopus. The search was limited to studies published from December 2019 until May 2023, resulting in a total of 3727 studies. After quality appraisal using the CASP checklists version 2018, 29 articles were included in the final review. Data analysis was performed using thematic analysis. RESULTS Most of the studies reviewed had used the proprietary platforms (N = 14) and 11 studies had used public platforms such as social messengers or email. Also 9 studies relied on phone calls (N = 9) to record and transmit the clinical data. Some studies had applied two different approaches (proprietary/public platforms and phone). six articles (20.7%) focused only on hypertension control, while 23 articles (79.3%) examined hypertension as a comorbidity with other diseases. Also, the study identified 88 unique concepts, 15 initial themes, and six final themes for outcomes of using telemedicine for hypertension management during the COVID-19 pandemic. These themes include BP control, BP measurement and recording, medication management, mental health, care continuity and use and acceptance. CONCLUSION Telemedicine provides patients with hypertension with the opportunity to engage in medical consultations in a more convenient and comfortable manner, with the same validity as in-person visits. Telemedicine facilitates the creation of a connected network to support patients with high BP at any time and in any location. Limitations and issues may arise due to patients and healthcare staff's unfamiliarity with telemedicine. These issues can be resolved through the ongoing use and continuous feedback.
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Affiliation(s)
- Mohammad Hosein Hayavi-haghighi
- Department of Health Information Technology, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdullah Gharibzade
- Department of cardiology, School of medicine, Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Niloofar Choobin
- Faculty of Para-medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Haniyeh Ansarifard
- Faculty of Para-medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Ploux S, Strik M, Ramirez FD, Buliard S, Chauvel R, Dos Santos P, Haïssaguerre M, Jobbé‐Duval A, Picard F, Riocreux C, Eschalier R, Bordachar P. Remote management of worsening heart failure to avoid hospitalization in a real-world setting. ESC Heart Fail 2023; 10:3637-3645. [PMID: 37797957 PMCID: PMC10682851 DOI: 10.1002/ehf2.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS From a patient and health system perspective, managing worsening heart failure (WHF) as an outpatient has become a priority. Remote management allows early detection of WHF, enabling timely intervention with the aim of preventing hospitalization. The objective of the study was to evaluate the feasibility and safety of remotely managing WHF events using a multiparametric platform. METHODS AND RESULTS All patients enrolled in the heart failure remote management programme of the Bordeaux University Hospital Telemedicine Center between 1 January and 31 December 2021 were included in the study. Follow-up data were collected until 1 March 2022. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II symptoms and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. In total, 161 patients (71 ± 11 years old, 79% male) were followed for a mean of 291 ± 66 days with a mean adherence to the remote monitoring system of 80 ± 20%. Over this period, 52 (32.3%) patients had 105 WHF events, of which 66 (63%) were successfully managed remotely, the remaining requiring hospitalization. Freedom from WHF events and hospitalization at 300 days were 66% and 85%, respectively (P < 0.001 for the difference). Increased level of BNP was associated with an increased risk of WHF event [hazard ratio (HR) per unit increase in BNP: 1.001; 95% confidence interval (CI) 1-1.002; P = 0.001] and hospitalization (HR 1.002; 95% CI 1.002-1.003; P = 0.002). A decrease in the level of glomerular filtration rate was associated with an increased risk of hospitalization (HR per unit decrease in estimated glomerular filtration rate: 0.946; 95% CI 0.906-0.989; P = 0.014). WHF event recurrence and (re)hospitalization rates at 1-month were similar among patients managed remotely (18% and 12%, respectively) and those requiring hospitalization (21% and 10%, respectively). Iatrogenic complications occurred more often during hospitalization than remote management (26% vs. 3%, P < 0.001). CONCLUSIONS Our study suggests that remote management of WHF events based on a multiparametric approach led by a telemedical centre is feasible and safe. Adopting such a strategy for patients with chronic HF could reduce HF-related hospitalizations with expected benefits for patients, care providers, and health care systems.
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Affiliation(s)
- Sylvain Ploux
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Marc Strik
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - F. Daniel Ramirez
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Samuel Buliard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Rémi Chauvel
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Pierre Dos Santos
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Michel Haïssaguerre
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Antoine Jobbé‐Duval
- Department of Heart Failure and Transplant‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de LyonLyonFrance
| | - François Picard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Clément Riocreux
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Romain Eschalier
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Pierre Bordachar
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
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Taylor JK, Ahmed FZ. Clinical Pathways Guided by Remotely Monitoring Cardiac Device Data: The Future of Device Heart Failure Management? Arrhythm Electrophysiol Rev 2023; 12:e15. [PMID: 37427299 PMCID: PMC10326671 DOI: 10.15420/aer.2022.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/03/2022] [Indexed: 07/11/2023] Open
Abstract
Research examining the utility of cardiac device data to manage patients with heart failure (HF) is rapidly evolving. COVID-19 has reignited interest in remote monitoring, with manufacturers each developing and testing new ways to detect acute HF episodes, risk stratify patients and support self-care. As standalone diagnostic tools, individual physiological metrics and algorithm-based systems have demonstrated utility in predicting future events, but the integration of remote monitoring data with existing clinical care pathways for device HF patients is not well described. This narrative review provides an overview of device-based HF diagnostics available to care providers in the UK, and describes the current state of play with regard to how these systems fit in with current HF management.
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Affiliation(s)
- Joanne K Taylor
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Fozia Zahir Ahmed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Gruiskens JRJH, van Hoef L, Theunissen M, Courtens AM, van den Beuken-van Everdingen MHJ, Gidding-Slok AHM, van Schayck OCP. The Psychosocial Impact of the COVID-19 Pandemic on Chronic Care Patients. J Am Med Dir Assoc 2023; 24:426-433.e2. [PMID: 36781063 PMCID: PMC9841072 DOI: 10.1016/j.jamda.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/01/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure. DESIGN A qualitative survey using semi-structured interviews was held among patients with COPD and heart failure. SETTING AND PARTICIPANTS Using randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing. METHODS Inductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach. RESULTS We found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients. CONCLUSIONS AND IMPLICATIONS Health care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.
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Affiliation(s)
- Jeroen R J H Gruiskens
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth van Hoef
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Annerika H M Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Ghilencea LN, Chiru MR, Stolcova M, Spiridon G, Manea LM, Stănescu AMA, Bokhari A, Kilic ID, Secco GG, Foin N, Di Mario C. Telemedicine: Benefits for Cardiovascular Patients in the COVID-19 Era. Front Cardiovasc Med 2022; 9:868635. [PMID: 35935629 PMCID: PMC9347362 DOI: 10.3389/fcvm.2022.868635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
The recent pandemic with SARS-CoV-2 raises questions worldwide regarding telemedicine for housebound patients, including those with cardiovascular conditions. The need for further investigation, monitoring and therapeutic management are advancing practical issues which had not been identified for consideration prior to the pandemic. Using the marketing assessment, we identified the needs of the patients and evaluated the future steps necessary in the short term to meet them. The research found progress made via telemedicine in monitoring and conducting minor decisions (like up-titrating the doses of different medication regimens) in patients with several cardiovascular diseases (heart failure, atrial fibrillation, high blood pressure), as there is a worldwide trend to develop new telemonitoring biosensors and devices based on implantable delivered transcatheter. The worldwide telemedicine trend encourages a switch from small and hesitating steps to a more consistent assessment of the patients, based on high technology and Interventional Cardiology. Cardiovascular telemedicine, although made a sustainable effort in managing patients' health, has many obstacles to overcome before meeting all their needs. Data security, confidentiality and reimbursement are the top priorities in developing remote Cardiology. The regulatory institutions need to play an integrative role in leading the way for defining the framework of future telemedicine activities. The SARS-CoV-2 outbreak with all its tragedy served to reinforce the message that telemedicine services can be life-saving for cardiovascular patients. Once the Covid-19 era will fade away, telemedicine is likely to remain a complementary service of standard care. There is still room to improve the remote identification and investigation of heart disease, provide an accurate diagnosis and therapeutic regimen, and update regulations and guidelines to the new realities of technological progress in the field.
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Affiliation(s)
- Liviu-Nicolae Ghilencea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Gabriel Spiridon
- Department and European Project Development, Institute of Scientific Research and Technological Development in Automation and Informatics, Bucharest, Romania
| | - Laura-Maria Manea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Awais Bokhari
- Department of Cardiology, Bedford Hospital NHS Foundation Trust, Bedford, United Kingdom
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Hospital, Denizli, Turkey
| | - Gioel Gabriel Secco
- Department of Interventional Cardiology and Structural Heart Disease, SS. Antonio e Biagioe Cesare Arrigo Hospital, Alessandria, Italy
| | - Nicolas Foin
- Duke-NUS Medical School, National Heart Research Institute, Singapore, Singapore
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
- Royal Brompton Hospital, NHSFT, London, United Kingdom
- Department of Cardiology, University of Florence, Florence, Italy
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