PhD Scientific Days 2023

Clinical Medicine I.

Remote management of patients with cardiac implantable electronic devices during the COVID-19 pandemic

Text of the abstract

Introduction: The recent technological advancements in the treatment of patients with cardiac implantable electronic devices (CIED) have expanded the options for remote monitoring (RM).
Aim: To assess if telecardiology is a safe alternative to routine outpatient examination.
Method: We analyzed data from patients with CIED devices from January 1st to March 15th, 2020; March 16th to June 18th, 2020; and June 19th to August 31st, 2020. The following objective indicators were used: number of outpatient visits during the observed periods, number of acute decompensation episodes, and RM data sent by the CIED device (intrinsic rhythm, CRT stimulation, ventricular and chamber rhythm, chamber impedance, patient activity, heart rate variability, and extrasystole). Subjective indicators were assessed using general condition questionnaires (KCCQ, EQ-5D-5L). Descriptive statistics, Kruskal-Wallis test, ANOVA and Friedman test were performed for comparison of periods. Correlations identified were compared using time series decomposition, examining the level, trend, seasonality, and combination of noise components of the data sets.
Results: 85 patients were included in the study. The number of personal appearances in the outpatient clinic was on average 1.4±1.4 in the year following the outbreak of the pandemic, compared to 1.9±1.2 before (p=0.0077). The number of acute decompensation events was 5 before and 7 during lockdown (p=0.6). Based on RM data provided by CIED, there was a significant difference in markers of heart failure (HF): patient activity increased after lifting restrictions compared to before lockdown (p=0.03), while chamber pacing was higher during lockdown (p<0.001). During restrictions, patients reported stronger anxiety and depression compared to their previous state (p<0.001), while there was no subjective change in the perception of HF symptoms between the pre-pandemic period and the time of restrictions (p=0.7).
Conclusion: Based on the subjective perception and CIED data, the quality of life of patients with CIED devices did not deteriorate during the pandemic restrictions, but anxiety and depression increased. Telecardiology may be a safe alternative to routine outpatient examination.
Funding: The study was supported by the MD-PhD Excellence Program of Semmelweis University (EFOP-3.6.3-VEKOP-16-2017-00009) and by grant EFOP-3.6.3-VEKOP-16-2017-00009 (“Semmel-weis 250+ Excellence Scholarship”).