Characteristics and Outcomes of Recipients of Heart Transplant with Coronarvirus Disease 2019 Who Received Casirivimab Plus Imdevimab Infusion

Purpose

Heart transplant (HT) recipient are at increased risk of adverse outcomes following COVID-19 infection and may benefit from monoclonal antibody infusion to mitigate progression to clinically severe disease. The aim of this study is to describe the outcomes of HT patients who experienced mild to moderate coronavirus disease 2019 (COVID-19), with subsequent administration of casirivimab plus imdevimab administration.

Methods

A retrospective review of all HT recipients who were infected with COVID-19, and subsequently infused with monoclonal antibodies in a large academic medical center between January 1, 2021 to September 1, 2021.

Results

14 HT patients were included in the analysis. The median age was 57.5 (interquartile range [IQR], 41.5-64) years, 10 (71%) were men, and median time from HT was 3.48 (IQR, 1.00-11.82) years. Comorbid conditions included hypertension in 6 patients (43%), diabetes in 4 (29%), and chronic kidney disease in 6 (43%). Eight patients (57%) were previously vaccinated, predominantly with the Pfizer-BioNTech vaccine. Three participants (21%) were admitted after clinical progression of COVID-19. Among patients managed at the study institution, mycophenolate mofetil was discontinued in two patients (14%) and calcineurin inhibitor was maintained at previous levels in all fourteen patients (100%). Of the admitted patients, 1 was treated with high dose corticosteroids alone and 2 were treated with corticosteroids plus remdesivir. No patient required intubation. All 3 patients were discharged home and no patients in this cohort died.

Conclusion

In this single-center case series, HT patients with mild-moderate COVID-19 who were treated with monoclonal antibody infusion had a hospitalization rate of 21% and 100% survival. Further studies are required to optimize management of COVID-19 infection in the HT population.

The use of telemedicine in cardiogenetics clinical practice during the COVID-19 pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic has necessitated the widespread adoption of telemedicine, and while many clinics have now re-established in-person patient visits, telemedicine is likely to continue to play an important role in health care delivery. In particular, the embrace of telemedicine presents an unprecedented opportunity through which to expand the reach of genetic counseling, i.e., telegenetics.

Purpose

The aim of this study was to examine the impact of COVID-19 on genetic counseling practices within the cardiogenetics clinics at a large academic center in New York City.

Methods

We retrospectively analyzed clinical characteristics of patients who were seen for cardiovascular genetic counseling visits pre-pandemic between April 1, 2019 through December 23, 2019 and during the pandemic between April 1, 2020 through December 23, 2020 at Columbia University Irving Medical Center. Genetic testing results were recorded for each encounter when available.

Results

Overall, 104 patients had a cardiovascular genetic counseling visit in 2019 compared to 132 patients in 2020 (Table). Only 6% (n=6) of visits in 2019 were remote telemedicine encounters whereas 80% (n=106) of visits in 2020 were telemedicine encounters. There was a significant increase in the number of family members seen for genetic counseling in 2020; in 2019 only 15% (n=16) of the patients seen for genetic counseling were family members of probands whereas this percentage increased to 34% in 2020 (n=45; p=0.002). In addition, in 2020 the geographic reach of genetic counseling extended far beyond New York state, reaching a total of 11 states as well as one patient in Puerto Rico (Figure). Genetic testing results were similar between the two years with 29% of patients found to be genotype positive in 2019 and 29% of patients genotype positive in 2020 (p=0.91). Notably, of those patients who underwent telemedicine visits and were sent genetic testing kits (n=106), 14% (n=15) did not return a sample.

Conclusions

In this study we found that despite the health care delivery barriers created by the COVID-19 pandemic, the use of telemedicine allowed us to not only continue seeing patients for cardiovascular genetic counseling visits but also to expand the reach of genetic counseling and testing beyond the geographical boundaries of our previous catchment area. Telegenetics offers patients and clinicians convenience and flexibility and has likely earned its permanent place in clinical practice. Future efforts are warranted to study the longer-term clinical impacts of telegenetics as well as to continue to improve telemedicine technology, with the ultimate aim of increasing patient access to personalized genomic medicine.

Funding Acknowledgement

Type of funding sources: None.

The Utility of Televisits in Patients with Cardiac Amyloidosis during the COVID-19 Pandemic

Purpose

In the era of COVID-19, the televisit has become a critical means of providing healthcare for patients unable to attend in-person visits. Transthyretin and light chain amyloidosis are complex diseases, that require frequent and close follow up. The aim of this study was to assess the utility and effectiveness of televisit encounters for patients with cardiac amyloidosis (CA) during the COVID-19 pandemic.

Methods

This was a prospective cohort study of consecutive patients with CA who were evaluated by televisit between March and May, 2020, at a large academic medical center. Patient demographics, baseline medications and details of televisit encounters were collected from electronic medical records. Patients were followed for 3 months from their first televisit for medication changes, in-person clinic visits, hospital admissions, and mortality.

Results

Ninety-eight patients with CA were included. Mean age was 76.5±9.1 yrs and 79 were male (80.6%). The number of televisits per patient is shown in Figure 1a. Over 3-months follow-up, 26 patients (26.5%) were seen for either an in-person clinic visit or right heart catheterization. There were 7 emergency room visits, of which 4 (4.1%) resulted in hospital admission, 1 patient (1.0%) had multiple admissions and no patient died (Figure 1b). None of the hospital admissions occurred within two weeks of a televisit. Hospital admissions were due to heart failure exacerbation, sepsis, acute kidney injury and dehydration secondary to diarrhea. During follow-up, 23 patients (23.5%) had medication adjustments, most commonly changes in diuretic (56.5%) and mineralocorticoid receptor antagonist (56.5%) doses. Two patients were newly initiated on tafamidis, for treatment of transthyretin CA.

Conclusion

The use of televisits for the management of patients with CA is feasible, and the low admission rate indicates that televisits are a safe and effective way to manage CA patients in the outpatient setting.