[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]

Blackground and objective

Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area.

Methods

Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018.

Results

We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018.

Conclusions

The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

A universal electronic consultation programme at the cardiology department after general practitioner referrals to improve healthcare accessibility and outcomes in elderly patients

Background

The on-line healthcare models are an opportunity to improve the accessibility and efficiency in clinical assistance, however, analyses of the effects of outpatient care on healthcare quality, including safety, are limited, particularly in vulnerable populations such as elderly patients 1. The care of elderly patients (generally >80 years) is usually characterized as having more chronic pathologies, particularly more cardiovascular diseases, resulting in having a worse risk profile 2. However, this group is also usually characterized by problems with functionality and dependency that can increase difficulties in moving from their homes to health care centres, particularly in areas of great geographical dispersion such as in our study 3.

The healthcare systems that have integrated electronic clinical records between different assistance levels provide an electronic consultation (e-consultation) as a first step of ambulatory care for all general practitioner (GP) referrals. Healthcare systems that include an e-consultation have already shown favorable health outcomes and reduced displacement of the population served 4,5 and could also improve accessibility to outpatient care, although there are not results to demonstrate its safety in this particular group of high-risk patients.

Purpose

We aimed to assess the accessibility and health outcomes (hospital admissions and mortality) in elderly patients referred to a cardiology department (CD) from primary care after inclusion of an e-consultation in outpatient care.

Methods

We included 9,963 patients >80 years old referred to the CD from January 1st, 2010, to December 31st, 2019. In 2013, we instituted an e-consultation programme (2013–2019) for all primary care referrals to cardiologists that preceded patient in-person consultations when considered. We compared both models (in-person consultation and e-consultation) using I: an interrupted time series regression on delay time, hospital admission, and mortality, II: the accessibility measured as population-adjusted referred rate in both periods, and III: analysing the changes in each municipality in delay time, hospital admission and mortality.

Results

During the e-consult period, the demand of care increased (12.8±4.3% vs 25.5±11.1% per 1,000 inhabitants, p<0.001), delay for care was reduced (−0.094 days; 95% CI [−0.063, −0.140], p<0.001), and age-dependent delay disappeared. After the implementation of e-consults, hospital admission (incidence rate ratio [iRR]: 1.351 [95% CI, 0.787, 2.317], p=0.874), Figure 1, and mortality (iRR: 1.925 [95% CI: 0.889, 4.168], p=0.096) stabilised with a slight downward trend, Figure 2.

Conclusion

Implementation of e-consultations in the outpatient care programme in CD was associated with improved access to cardiology healthcare in elderly patients. After the implementation of the e-consultation, hospital admissions and mortality were stabilised and showed a slight non-significant downward trend.

Funding Acknowledgement

Type of funding sources: None.

Leadless pacemaker implant with concomitant atrioventricular node ablation: experience in a single center study with longterm followup

Introduction

Feasibility of concomitant leadless-pacemaker (LP) implantation plus atrioventricular node ablation (AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming.

Objective

We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes.

Methods

Single center, prospective and observational study of 256 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 255/256 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results

33 out of 255 patients underwent immediate AV ablation. Mean age was 75.2±8.3 years. Were predominantly females: 25 (75.7%) and indication was fast conduction atrial fibrillation (n=25), atypical flutter or atrial tachycardia (n=8). Mean acute “R wave” was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.

There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 27.9±12 months, all patients remained alive without notable event, and electrical parameters remained unchanged (Figure 1). Actuarial survival was shown in Figure 2.

Conclusions

Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period.

Funding Acknowledgement

Type of funding sources: None. Electrical performanceSurvival

Leadless pacemaker implant with concomitant atrioventricular node ablation: a single center study with longterm followup

Funding Acknowledgements

Type of funding sources: None.

Introduction

Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming .

Objective

We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes. 

Methods

Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results

33 out of  242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.

There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of  19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1)

Conclusions

Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run.  In our  experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance