How Physicians Can Help Ease Pandemic Stress for Cardiac Patients
By David Hayes M.D.
The true toll COVID-19 has taken on public health around the world is difficult to pinpoint at the moment - but it’s much higher than the official death toll from the virus itself.
When physicians noted a 50 percent decrease in heart attacks, the European Society of Cardiology hypothesized that patients were staying away from the emergency room because they were afraid they would contract COVID-19. They also noted that among patients who did seek treatment, 48 percent arrived later than normal, i.e. beyond the ideal time window to receive treatment and minimize damage.
Both the ESC and the American College of Cardiology publicly urged potential heart patients to not delay their visits to the emergency room. The CEOs of The Cleveland and Mayo Clinic went so far as to pen a joint op-ed in the New York Times emphasizing that hospitals were safe, and that patients requiring care needed to seek hospital care as they normally would. So how do we, as physicians, help reassure our patients and help them deal with the stress that makes them wonder whether they should put off heading to the hospital?
The first step is to assure our patients that hospitals are taking measures to separate actual and suspected COVID-19 patients from non-COVID-19 patients, and that seeking care is safe. The second step is to remind them to seek urgent medical care as they normally would. Finally, we can use contemporary remote monitoring technologies to optimize care at a distance without our patients having to leave home.
The benefits of remote cardiac monitoring have been examined in several studies since its introduction in 2000, with varied opinions about when and how it should be used. The pandemic, however, has prompted us to look at this innovation from a new perspective. The Heart Rhythm Society’s COVID-19 Taskforce recommends physicians make every effort to perform CIED interrogations via remote monitoring rather than in-person. The findings of the recent At-Home study*, where researchers in Japan found no significant difference in safety between pacemaker patients who were followed remotely and patients who were followed conventionally, are particularly timely. At-Home builds on the earlier RM-ALONE trial*, in which researchers in Spain also found no significant safety difference in between the two groups and in addition noted a striking staff workload reduction of around 40 percent.
Technologies like remote monitoring allow us to help alleviate that stress, by reassuring our patients that we are taking every precaution we can.
Recent remote monitoring studies should give us a new sense of optimism that we can conduct the majority of cardiac device follow-ups with our patients that at a distance. With remote monitoring it is important that we do so without compromising quality of care, multiple studies have demonstrated improved outcomes, detection and treatment of device related issues earlier when compared to reliance on in-office visits. While the benefits for practicing physicians may be clear, we shouldn’t forget the stress the pandemic is also putting on our patients. Using technologies like remote monitoring allows us to help alleviate that stress, by reassuring our patients that we are taking every precaution we can.
Earlier this week, I talked through some strategies on how physicians can help bolster patient confidence during COVID-19. To access the free video content you can sign up here.
*Disclaimer: This study utilized remote only follow-up of patients for 24 months. Remote only follow-up for 24 months has not yet been approved for the product labeling and cannot be recommended by BIOTRONIK at this time.