Telemedicine: an Effective and Low-Cost Lesson From the COVID-19 Pandemic for the Management of Heart Failure Patients

Abstract

Purpose The purpose of this review is to explore the benefits and controversies that telemedicine (TM), applied to patients with heart failure (HF), can provide in terms of diagnosis, therapeutic management, and prognosis improvement. Recent Findings and Summary During the coronavirus disease 19 (COVID-19) outbreak, TM emerged as the most effective and feasible method available to ensure continuous care for chronic diseases. Among these, HF, characterized by high mortality, morbidity, and the need for frequent visits, may benefit of the TM role. HF patients are affected by frequent exacerbations undergoing a progressive prognosis impoverishment, strongly depending on the disease’s management. A precise clinical handling is always required, with a constant optimization of the therapy, a continuous control of risk factors, and a sensitive attention to any change in symptoms, clinical signs, and laboratory tests. In this context, TM has shown to improve therapy adherence and HF: patients’ self-care, impacting the prognosis even if specific results are controversial. Major evidence shows that TM may allow an adequate primary prevention, reducing the impact of the main cardiovascular risk factors. TM can also be useful for the secondary prevention, early detecting a likely HF exacerbation before it becomes clinically manifest, thereby lowering the need for hospitalization. Moreover, an optimal up-titration of the therapy and an increase in treatment adherence are feasible by using TM. However, some studies did not show unambiguous results, and uncertainties still remain. Graphical Abstract

Strategy for an early simultaneous introduction of four-pillars of heart failure therapy: results from a single center experience

“…During the vulnerable period, hospitalization and therefore disease progression drastically affect patient's prognosis. The proper optimization of GDMT remains a difficult goal to be achieved for a large number of patients in real practice [22,23,[27][28][29]. Many pharmacological treatment strategies have been hypothesized regarding the management of HF [14][15][16][17][18].…”

Current Approaches to Worsening Heart Failure: Pathophysiological and Molecular Insights

“…This real-time monitoring allows prompt adjustments in medication and treatment plans, mostly concerning changes in diuretic dose, in order to prevent HF exacerbations and hospitalizations; its role in HF management was stated in the latest HF guidelines with a class IIb, level B recommendation [1]. Patients with high PAP are more susceptible to decompensation, and different studies have explored the role of home telemonitoring (HTM) in this scenario [63][64][65][66].…”