Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 23;16(3):e0249043.
doi: 10.1371/journal.pone.0249043. eCollection 2021.

The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure

Sarinya Puwanant  1   2 , Supanee Sinphurmsukskul  1   2 , Laddawan Krailak  1   2 , Pavinee Nakaviroj  1   2 , Noppawan Boonbumrong  1   2 , Sarawut Siwamogsatham  1   2 , Krailerk Chettakulanurak  1   2 , Aekarach Ariyachaipanich  1   2 , Smonporn Boonyaratavej  1   2
Affiliations

The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular mortality and heart failure hospitalization in ambulatory patients with heart failure

Sarinya Puwanant et al. PLoS One. .

Abstract

Background: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic.

Methods: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit.

Results: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group.

Conclusions: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Rates of cardiovascular mortality, heart failure hospitalization, and heart transplantation during pre-COVID-19, peak COVID-19, and post-COVID-19 periods of 2020 and corresponding periods in 2019.
Fig 2
Fig 2. Rates of medical titration during pre-COVID-19, peak COVID-19, and post-COVID-19 periods of 2020.
See this image and copyright information in PMC

References

    1. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al.. COVID-19 and Cardiovascular Disease. Circulation. 2020;141:1648–1655. 10.1161/CIRCULATIONAHA.120.046941 - DOI - PubMed
    1. Nishiga M, Wang DW, Han Y, Lewis DB and Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17:543–558. 10.1038/s41569-020-0413-9 - DOI - PMC - PubMed
    1. Andersson C, Gerds T, Fosbol E, Phelps M, Andersen J, Lamberts M, et al.. Incidence of New-Onset and Worsening Heart Failure Before and After the COVID-19 Epidemic Lockdown in Denmark: A Nationwide Cohort Study. Circ Heart Fail. 2020;13:e007274. 10.1161/CIRCHEARTFAILURE.120.007274 - DOI - PubMed
    1. Bromage DI, Cannata A, Rind IA, Gregorio C, Piper S, Shah AM, et al.. The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic. Eur J Heart Fail. 2020;22:978–984. 10.1002/ejhf.1925 - DOI - PMC - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, et al.. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:1810–52. 10.1161/CIR.0b013e31829e8807 - DOI - PubMed

MeSH terms