Digital Health Aids Electrophysiology Practice During COVID-19 Pandemic and Beyond

By Will Boggs MD

July 02, 2020

NEW YORK (Reuters Health) - Digital health can facilitate electrophysiology practice for patients with arrhythmia during and after the COVID-19 pandemic, according to an international practice update.

"The pandemic, by forcing use of remote patient management tools, has illustrated benefits to both patients and clinics and is going to have an ever-increasing presence in everyday clinical practice," Dr. Niraj Varma of Cleveland Clinic, in Ohio, told Reuters Health by email.

In a report in the Journal of the American College of Cardiology, Dr. Varma and colleagues representing the American Heart Association, the American College of Cardiology, the Latin American Heart Rhythm Society, the Heart Rhythm Society, the European Heart Rhythm Association, and the Asia Pacific Heart Rhythm Society discuss how digital health can contribute to electrophysiology practice.

Especially during the current pandemic, monitoring strategies should focus on selecting high-risk patients in need of close surveillance and using remote-recording devices to preserve personal protective equipment and protect patients and healthcare workers from potential contagious harm, according to the report.

Mobile health devices with ECG-recording capabilities can play a role not only in inpatient and outpatient management, but also as tools for virtual consultations in electrophysiology, the authors say.

During the COVID-19 pandemic, digital health might be particularly useful for monitoring patients whose treatments include medications with QT-prolonging effects, they add.

Barriers to implementation of digital health include inadequate reimbursement, licensing/regulatory and privacy issues, lack of infrastructure, resistance to change, lack of access/poor Internet coverage, restricted financial resources, and limited technical skills among some patient populations.

"Regulatory and reimbursement bodies, which have traditionally moved slowly, moved rapidly to approve use of telehealth and remove/reduce barriers, thus permitting widespread adoption across traditional boundaries, e.g., patient management across state lines, use of ambulatory monitoring devices within hospitals, etc.," Dr. Varma said.

The report provides examples of commonly used platforms for telehealth, as well as currently available handheld devices, mobile cardiac telemetry devices and smartwatches.

The increasing acceptance of these platforms and devices will likely sustain their use even beyond the current pandemic and provide a solution for intensive monitoring extending beyond the hospital environment.

Coauthor Dr. Nassir F. Marrouche of Tulane University School of Medicine, in New Orleans, Louisiana, told Reuters Health by email, "Digital health and telemedicine are here to stay. Our patients and consumers have been 'empowered' by digital health/wearables and adaptability is inevitable."

"I have never seen or experienced such a unified global adoption of a change in medicine like the adoption of digital medicine," he said.

Dr. Stefano Omboni of the Italian Institute of Telemedicine, in Varese, who was not involved with the report, told Reuters Health by email, "Telehealth for arrhythmia monitoring is a promising solution, particularly for monitoring frail patients at home (elderly, patients with heart disease or any other chronic conditions affecting the heart). These solutions must be particularly user-friendly and able to easily and timely communicate with healthcare professionals in charge."

"It would be very important to empower primary-care clinics and pharmacies located in the community and remotely connected with secondary or tertiary facilities, which may serve as the point of contact for patients needing telemonitoring of cardiac parameters in the absence of a specialist," he said. "This will reduce the burden on specialized healthcare facilities and yet allow effective continuity of care. In this regard, our experience is successful and very positive in Italy."

Dr. Jedrek Wosik of Duke University School of Medicine, in Durham, North Carolina, who recently reviewed the rise of virtual care during the COVID-19 pandemic, told Reuters Health by email, "Lessons learned by electrophysiologists or heart-rhythm doctors during this COVID-19 period can be applied across telemedicine and healthcare."

"Smartphone-based devices and measurements will be crucial during this period as well, as there is still a limited supply of telemetry wards and devices," said Dr. Wosik, who also was not involved with the new paper. "The experience gained during the pandemic monitoring patients with implanted cardiac devices will be invaluable to all."

SOURCE: Journal of the American College of Cardiology, online June 11, 2020