Adaptations of paediatric cardiology practice during the COVID-19 pandemic

Fremed, Michael; Niaz, Talha; Hope, K.D.; Altman, Carolyn A.; Levy, Victor Y; Glickstein, Julie S.; Johnson, Jonathan N.

doi:10.1017/s1047951121004364

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…There are limited studies in the literature on the use of troponin levels and the potential role in predicting the cardiac involvement of COVID-19 in children [ 8 – 10 ]. In addition, when to have a consultation for a cardiology specialist is not clear, and the previous studies reported an increased workload of the pediatric cardiology department [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

et al. 2022

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Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2–max. 144) months, which was statistically lower than the age of patients with normal troponin levels ( P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay ( P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels ( P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.

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Section: Introductionmentioning

confidence: 99%

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

et al. 2022

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“…Certain subspecialties or disciplines within a subspecialty may be more suited than others for adoption of telehealth visits, as has been shown among various pediatric subspecialties [12]. For example, based on a national survey amongst pediatric heart center physicians, preventative cardiology visits, pre-procedural counseling, post-procedural counseling, and electrophysiology were thought to be better candidates for virtual appointments [13]. This was particularly true for pediatric electrophysiology patients who reported a high rate (98%) of patient satisfaction with their telehealth appointment and ancillary testing supporting the potential for sustainability of telehealth long term for pediatric electrophysiology [14].…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric cardiologists have also utilized more remote monitoring options such as pulse oximeter, Holters and home blood pressure monitors. 13 The AAP and Section on Telehealth Care's Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT) network have been collaborating to improve pediatric telehealth and aim to focus on "feasibility and usability, equitability and outcome measurement" [16]. Given this focus, prior literature, and our ndings, consideration must be given to create a more robust telemedicine system for speci c subsets within pediatric cardiology to easily access telemedicine moving forward (electrophysiology, preventative cardiology, etc.).…”

Section: Discussionmentioning

confidence: 99%

Remote Care Adoption in Underserved Congenital Heart Disease Patients during the COVID-19 Era

Morrison

Moore

Moreno

et al. 2022

Preprint

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Objective The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. Methods We performed a retrospective chart review of Texas Children’s Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). Results We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10–17 yo) was associated with increased telemedicine (OR 2.05, 95%CI 1.73, 2.45) and patient portal use (OR 1.70, 95%CI 1.33, 2.18). Public insurance (OR 1.73, 95%CI 1.31, 2.29) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Conclusion Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.

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“…Certain subspecialties or disciplines within a subspecialty may be more suited than others for adoption of telehealth visits, as has been shown among various pediatric subspecialties [ 15 ]. For example, based on a national survey amongst pediatric heart center physicians, preventative cardiology visits, pre-procedural counseling, post-procedural counseling, and electrophysiology were thought to be better candidates for virtual appointments [ 16 ]. This was particularly true for pediatric electrophysiology patients who reported a high rate (98%) of patient satisfaction with their telehealth appointment and ancillary testing supporting the potential for sustainability of telehealth long term for pediatric electrophysiology [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Adult subspecialties with a greater percentage of telemedicine visits also experienced a higher number of new patient visits [ 18 ]. Pediatric cardiologists have also utilized more remote monitoring options such as pulse oximeter, Holters and home blood pressure monitors [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

et al. 2022

View full text Add to dashboard Cite

The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children’s Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use ( p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients ( n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10–17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-022-03042-4.

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Adaptations of paediatric cardiology practice during the COVID-19 pandemic

Cited by 4 publications

References 12 publications

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

Remote Care Adoption in Underserved Congenital Heart Disease Patients during the COVID-19 Era

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

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