The COVID-19 Epidemic Has Proven the Value of Telemedicine and Out-of-Hospital Management and Intervention in Cardiovascular Disorders

Hello and welcome to the December 2021 edition of Vascular Disease Management. As usual, there are several excellent articles and case presentations worthy of commentary. I have chosen to comment on Drs. Ludovica Ettorre and Jos van den Berg’s article “The Current Global Pandemic and Its Impact on CLI.”

I have chosen to comment on this article, which addresses the treatment challenges during the initial two waves of the COVID-19 epidemic, for many reasons. It highlights the shortcomings of the global reliance on hospital-centric care where capacity and infection risk have delayed care and have resulted in increased amputation risk and mortality during the first 2 waves of the coronavirus pandemic. It describes the evolutional advancements made between the first and second waves of the pandemic. There is commentary on the utility of telemedicine to evaluate and follow patients with less infection risk and less need for travel. The article highlights the shift of interventional therapy and wound healing to outpatient and in-home settings where there is far less risk of infection exposure and none of the mandates common in hospitals that allow only emergency treatment secondary to decreased staff and bed capacity. Delays in timely care have adverse consequences, which are appropriately delineated.

This article was submitted before the new third wave of COVID-19 (the Omicron variant) was discovered. Many experts prognosticate that this variant may spread more easily but may be less severe in symptomatic presentation. If these predictions are correct, out-of-hospital assessment and intervention to avoid exposure risk may be even more important than it was in the first 2 waves. The emergence of the third wave must concern all that there may be subsequent mutations and new therapeutic challenges resulting in protracted challenges in the evaluation and treatment of patients presenting with cardiovascular disorders in a more timely and effective manner.

While the article in this issue specifically addresses peripheral arterial disorders, we must all recognize that the COVID-19 pandemic has adversely affected outcomes in all cardiovascular disorders because of decreased access to facilitate diagnosis, decreased diagnostic testing capabilities, impaired follow-up, increased risk of thrombotic and bleeding complications secondary to COVID-19 infection, and delayed treatment progression to definitive therapy in patients with progressive underlying obstructive disease. Delays in administering appropriate early treatment may result in subsequent emergency presentation where results are less optimal. It may be appropriate to question whether at least some of the mortality that has been attributed to COVID-19 alone may have been amplified significantly by the presence of underlying, untreated, highly significant cardiovascular disorders followed by subsequent contraction of COVID-19 infection.

As noted by the authors, the COVID-19 pandemic has proven the utility of a significant move toward the incorporation of telemedicine and the outpatient medical and interventional treatment of cardiovascular disorders. These therapies are preferred by most patients for their improved convenience, substantially less associated cost, no need for travel, and dramatically less risk of infection exposure. COVID-19 has been a catalyst, resulting in increased adoption of utilization of these promising trends.

Prior to the COVID-19 pandemic, reimbursement of telemedicine was poorly compensated, resulting in poor utilization of this convenient, and subsequently proven to be lifesaving, technology. COVID-19 has resulted in significant technological advancements in telemedicine options, making it more user friendly and improving diagnostic and follow-up capabilities. As with most new technologies, I suspect that now that providers have had to utilize this technology during the pandemic it will become more routinely utilized long after we have progressed beyond this saga.

I also suspect that hospitals will recognize the limitations of in-hospital treatment of cardiovascular disorders and move toward increased outpatient delivery of care.

Healthcare at present has many challenges. It is expensive and inconvenient. There is a major shortage of healthcare workers, resulting in decreased staffed hospital beds. The reported bed shortage is closely related to an inability to staff beds rather than a physical lack of bed capacity. COVID-19 vaccination mandates are now further contributing to the shortage of qualified healthcare worker availability as some workers object to vaccination based on religious beliefs, healthcare concerns, or the belief in those who have already contracted COVID-19 that vaccination may pose risk without additional associated benefit. Until these concerns have been definitively addressed, the shortage of healthcare workers will persist.

Telemedicine and outpatient treatment may be pivotal in improving outcomes with future non-COVID infectious epidemics or completely new and distinct infectious epidemics.   

COVID-19 has forced healthcare workers to adopt new technologies. I firmly believe that these new treatment algorithms will result in positive changes that will not only persist but continue to evolve favorably well into the future.