Telemedicine in myocarditis: Evolution of a mutidisciplinary "disease unit" at the time of COVID-19 pandemic

Abstract

Myocarditis Disease Unit (MDU) is a functional multidisciplinary network designed to offer multidisciplinary assistance to patients with myocarditis. More than 300 patients coming from the whole Country are currently followed up at a specialized multidisciplinary outpatient clinic. Following the pandemic outbreak of the SARS-CoV-2 infection in Italy, we present how the MDU rapidly evolved to a "tele-MDU", via a dedicated multitasking digital health platform.

Graphical abstract

Figure 1

Applications of telemedicine to MDU. Telemedicine applications to MDU are summarized. Left panel: The main facilities of the adopted web platform (top) are presented together with the new organization of data flows (bottom) at the time of COVID-19 pandemic. Although all myocarditis patients were discussed by tele-MDU, to optimize resources most of the televisits were performed by designated referral physicians (RPs) via hybrid models of care (including video/phone calls, secure email, or in-person visits for urgent cases). Right panel: The main advantages and drawbacks felt by both patients (top) and physicians (bottom) are reported. Further detail are reported in online supplements. COVID-19, disease caused by the severe acute respiratory syndrome coronavirus 2 during the current worldwide pandemics; EMR, Electronic Medical Records; MDU, Myocarditis Disease Unit; RPs, referral physicians.

Figure 2

Tele-MDU functions at the time of COVID-19 pandemic Tele-MDU functions during the COVID-19 pandemic are shown for both the inpatient (left panel) and outpatient arenas (right panel). Left panel: Inpatient arena: during the in-hospital phase (A), patients were discharged as soon as clinically acceptable, even before knowing the results of endomyocardial biopsy; the definite diagnosis of myocarditis, and subsequent therapeutic and follow-up plans were communicated via telemedicine (B). Right panel: Outpatient arena: in clinically stable outpatients, follow-up timeline was defined by the tele-MDU (A), according to the predefined polyambulatory agenda; in the presence of symptoms or signs suggesting clinical instability, as assessed by the referral physician and notified to the MDU, a patient-centered approach was applied (B): in particular, additional MDU telemeetings were planned, or at least a priority was assigned, to ensure a prompt decision making. COVID-19, disease caused by the severe acute respiratory syndrome coronavirus 2 during the current worldwide pandemics; MDU, Myocarditis Disease Unit; RPs, referral physicians.