Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

Giovanna Manzi; Silvia Papa; Marco Valerio Mariani; Gianmarco Scoccia; Domenico Filomena; Claudia Malerba; Francesca Ileana Adamo; Annalisa Caputo; Claudio De Lazzari; Beatrice De Lazzari; Nadia Cedrone; Rosalinda Madonna; Tommaso Recchioni; Giorgia Serino; Carmine Dario Vizza; Roberto Badagliacca

doi:10.1016/j.vph.2022.107024

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

Vascul Pharmacol. 2022 Aug:145:107024. doi: 10.1016/j.vph.2022.107024. Epub 2022 Jun 16.

Authors

Giovanna Manzi¹, Silvia Papa², Marco Valerio Mariani³, Gianmarco Scoccia⁴, Domenico Filomena⁵, Claudia Malerba⁶, Francesca Ileana Adamo⁷, Annalisa Caputo⁸, Claudio De Lazzari⁹, Beatrice De Lazzari¹⁰, Nadia Cedrone¹¹, Rosalinda Madonna¹², Tommaso Recchioni¹³, Giorgia Serino¹⁴, Carmine Dario Vizza¹⁵, Roberto Badagliacca¹⁶

Affiliations

¹ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: giovannamanzi91@gmail.com.
² Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: silviapapa83@gmail.com.
³ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: marcoval.mariani@gmail.com.
⁴ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: gianmarcoscoccia@gmail.com.
⁵ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: domenico.filomena@uniroma1.it.
⁶ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: claudiamalerba4@gmail.com.
⁷ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: francescaileana.adamo@uniroma1.it.
⁸ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: annalisa.caputo@uniroma1.it.
⁹ National Research Council, Institute of Clinical Physiology (IFC-CNR), Rome, Italy. Electronic address: claudio.delazzari@ifc.cnr.it.
¹⁰ Università degli Studi di Roma "Foro Italico", P.za Lauro De Bosis, 15, 00135 Rome, Italy. Electronic address: beatrice.delazzari@gmail.com.
¹¹ Unità di Medicina Interna, Ospedale S. Pertini, Rome, Italy. Electronic address: nadiacedrone@gmail.com.
¹² Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa - UNIPI, Pisa, Italy. Electronic address: rosalinda.madonna@unipi.it.
¹³ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: recchioni.1739479@studenti.uniroma1.it.
¹⁴ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: giorgia.serino@uniroma1.it.
¹⁵ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: dario.vizza@uniroma1.it.
¹⁶ Department of Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: roberto.badagliacca@uniroma1.it.

Abstract

Background: COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH).

Main body: The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities.

Conclusion: Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.

Keywords: COVID-19; Pulmonary arterial hypertension; Telecardiology; Telemedicine.

MeSH terms

COVID-19* / epidemiology
Humans
Pandemics / prevention & control
Pulmonary Arterial Hypertension* / diagnosis
Pulmonary Arterial Hypertension* / epidemiology
Pulmonary Arterial Hypertension* / therapy
RNA, Viral
Rare Diseases / epidemiology
SARS-CoV-2
Telemedicine*

Substances

RNA, Viral