The consequence of Covid-19
At the outbreak of the pandemic in early 2020, there was a unanimously manifest worry among cardiologists that heart failure admissions and mortality would rise steeply. This article attempts explaining some of the causes for the significant drop in admissions and what we could learn from it in future heart failure management.
A large proportion of people with COVID-19 needed active healthcare and hospital admission, and heart failure patients were identified as an articulated risk group, since poor cardiovascular health is one of the largest risk factors for a poor outcome in COVID-19 patients.(1) Among US heart failure patients the admissions significantly dropped. Several recent publications have concluded a handful of explanations.(2) Some may be deduced with armchair reasoning, while other may be more surprising.
During the pandemic it all suddenly became accepted with remote work, video conferences and hence, the rapid establishment of telemedicine. In the tenacious clinical world, such changes would normally have taken ages. Telehealth showed that tight follow-up online prevented patients from having to physically visit and queue for hours at the emergency departments. Instead, many patients were monitored online by their doctors every fortnight, for medical adjustments, which reduced admissions.
The heart failure group showed a clearly increased vaccination compliance; maybe as a consequence of articulated information about the dramatically increased risk for complications from COVID-19.(3)
Improved Patient Monitoring
The tighter follow-up and home monitoring increased the general medication compliance. People were at home, could focus on the disease and became more aware of their dietary intake. It has also been suggested that cooking their own food, instead of dining out, perhaps reduced stress and decreased the sodium intake. The fear of becoming admitted in the midst of the pandemic havoc, forced people to exercise, activate, and adopt healthier habits generally it seems. These suggestions are subjects of further research.
The Simultaneous Rise of Artificial Intelligence in Healthcare
In the recent few years there has been an exponential increase in the medical applications of artificial intelligence for healthcare. During the pandemic it became evident how AI could be used for prediction and image diagnostics (4),vaccine development and drug repurposing. (5) For heart failure, with the entry of a wireless intracardiac pressure monitor (ICPM), it will result in a superior boosting of more precise and evidence-based medication in this field. Hitherto, clinicians following-up their patients have had to trust unreliable clinical signs, such as lung rales and rattling (sensitivity 15%) or oedema (sensitivity 41%). There are clinical signs, detectable via telehealth follow-up though, such as orthopnoea (with ≥2 pillows) with 86% specificity, but with only 25% specificity. The jugular vein pressure has 66% sensitivity, but a positive predictive value of 75%. A wireless heart intracardiac pressure monitor has shown a 95% sensitivity and 96% positive predicate value, on the other hand.(6) This is hence an example of how AI could sensibly enhance the management of heart failure to avoid readmissions.
COVID-19 Infection and Heart Complications
New evidence shows that ‘anyone’ infected is at risk of heart complications –with cardiac inflammation, clotting and arrhythmias. A massive study, with cohorts of millions of patients, published in February 2022 shows an extended, significant rise in risk of cardiovascular complications, e.g., heart attacks and stroke, after a SARS-CoV-2 infection – even after a mild infection.(7) Researchers have started to map the frequency of these issues and their aetiology presented in a News Feature in Nature in August 2022.
Main Take Home Message
COVID-19 has taught us the value of frequent and remote patient monitoring and wise use of AI in heart failure management. The introduction of wireless intracardiac pressure monitors on wards, in the clinical surveillance and online follow-ups, would have a pivotal effect on clinical outcome. In essence, the positive effects of improved patient self-care, post discharge monitoring and enabling finely granular evidence-based medication could now come into fruition, with this new paradigm of heart failure management.