Nursing Teleconsultation for the Outpatient Management of Patients with Cardiovascular Disease during COVID-19 Pandemic

Abstract

Introduction: During the COVID-19 outbreak, non-urgent clinic visits or cardiac interventional procedures were postponed to a later date, and the implementation of telemedicine has guaranteed continuity of care for patients with chronic diseases. The aim of our study was to describe the medical interventions following nursing teleconsultation for the outpatient management of patients with cardiovascular diseases during the COVID-19 pandemic. Materials and Methods: All patients who did not attend the follow-up visit from 4th to 15th April 2020 at our institution and who were re-scheduled due to the COVID-19 lockdown were selected to be enrolled in the study. Each patient was followed by a semi-structured telephonic interview performed by a nurse. The outcomes of our study were to assess the patients’ adherence to nursing teleconsultation and the usefulness of nursing teleconsultation to detect clinical conditions in need of medical intervention. Results: In total, 203 patients (81%) underwent nursing teleconsultation in a mean time of 7± 3 days from the outpatient visit lost due to the COVID-19 lockdown. Furthermore, 53 patients (26%) showed poor adherence to nursing teleconsultation. Among the 150 patients (mean age 67± 10 years; 68% male) who completed the telephonic interview, the nursing teleconsultation revealed the need of medical intervention in 69 patients (46%), who were more likely at very high cardiovascular risk (77% vs. 48%; p < 0.0003) and who showed a higher prevalence of dyslipidemia (97% vs. 64%; p < 0.0001) and coronary artery disease (75% vs. 48%, p < 0.0008) compared to those not in need of any intervention. The up-titration of the lipid-lowering drugs (n: 32, 74%) was the most frequent medical intervention following the nursing teleconsultation. The mean time between the nursing teleconsultation and the date of the rescheduled in-person follow-up visit was 164 ± 36 days. Conclusions: Nursing teleconsultation is a simple and well-tolerated strategy that ensures the continuity of care and outpatient management for patients with cardiovascular diseases during the COVID-19 pandemic.

Nursing assistance in COVID-19 cardiovascular complications: Integrative Literature Review

“…However, telemedicine does not replace traditional health care, but integrates it to virtually improve efficacy, efficiency and adequacy. [19] There are three different ways to provide these services: synchronous, asynchronous and remote. Synchronous refers to the delivery of health information in real time, through the use of digital devices, allowing a live discussion with the patient or provider to provide medical expertise.…”

“…While the remote patient monitoring mode is obtained by means of an electronic device that records a continuous flow of information in real time about any patient that transmits data to a centralized website, which can be safely accessed by the healthcare team. [19] During the COVID-19 pandemic, teleconsultation helped professionals to avoid direct physical contact and minimize the risk of transmission by SARS-CoV-2, decreasing morbidity and mortality for Covid-19 and, finally, providing ongoing care to the community. [19] The strategy of replacing hospital visits with telecardiology has been effective in the short-term management of patients with cardiovascular diseases and patients prefer to continue with remote monitoring compared to the usual treatment.…”

“…[19] During the COVID-19 pandemic, teleconsultation helped professionals to avoid direct physical contact and minimize the risk of transmission by SARS-CoV-2, decreasing morbidity and mortality for Covid-19 and, finally, providing ongoing care to the community. [19] The strategy of replacing hospital visits with telecardiology has been effective in the short-term management of patients with cardiovascular diseases and patients prefer to continue with remote monitoring compared to the usual treatment. [19] The nurse's involvement in telemedicine consisted of establishing an approach to collect anamnesis data or educating the patient in the detection of vital parameters, collecting laboratory and instrumental examinations performed.…”

“…[19] The strategy of replacing hospital visits with telecardiology has been effective in the short-term management of patients with cardiovascular diseases and patients prefer to continue with remote monitoring compared to the usual treatment. [19] The nurse's involvement in telemedicine consisted of establishing an approach to collect anamnesis data or educating the patient in the detection of vital parameters, collecting laboratory and instrumental examinations performed. The findings of this study show that nursing in teleconsultation conducts semi-structured telephone interviews and electronic transmission of documents, having been a well-tolerated tool and accepted by 74% of the study population.…”

“…The findings of this study show that nursing in teleconsultation conducts semi-structured telephone interviews and electronic transmission of documents, having been a well-tolerated tool and accepted by 74% of the study population. [19] In the future, to expand the use of the model of nursing care through teleconsultation and to increase its credibility with patients, it would be necessary to officially recognize the telemedicine service and address the evolving concerns related to reimbursement policies and health laws licensing. It is necessary to carry out support training for nursing interviewers, oriented to ensure clear and effective communication and standardized telephone follow-up.…”