Delivering healthcare at distance to cardiac patients during the COVID-19 pandemic: Experiences from clinical practice

Abstract

The COVID-19 pandemic has accelerated how healthcare providers are working to deliver healthcare at distance. Many cardiac patients are now relying on phone and videoconference to receive medical care from home. The situation is pushing healthcare towards the future, leading to a leap forward for cardiac telemedicine. In this HeartBeat we highlight initiatives to deliver care at distance. The first program is the TeleCheck-AF (an initiative from Maastricht University Medical Centre+, The Netherlands), an on-demand and on-prescription mHealth program that includes a smartphone app (FibriCheck) for patients with atrial fibrillation (AF) (see Figure 1). Using the index finger and the phone’s camera, this app can detect the pulse, then use an algorithm to identify if the patient has AF and whether the heart rate is fast or slow. These vital data can be used by the physician to guide the teleconsultation and to monitor treatment at distance. Figure 1. The TeleCheck-AF approach. Professor Jeroen M Hendriks (Flinders University and Royal Adelaide Hospital, Australia) points out that the TeleCheck-AF is a user friendly and short intervention that puts the patient ‘in charge’ of their care by delivering vital data which may also result in better adherence to the treatment regime. Also, the data provided by the patient are stored in a cloud, are easily accessible and provides the healthcare professional with an overview of heart rhythm and rate as well as whether the patient has experienced AF-related symptoms. Patient perspective: ‘I am 78 years of age and much enjoyed to be part of this project. I strictly measured three times a day and had the feeling I was on top of my own care coordination.’ Poppy Brooks (Team leader Cardiac Support Services, North Devon Healthcare Trust, UK) responded to a call on our Twitter account (@EditorEJCN) in which we asked our followers to share how they give care to your patients at distance. Her team uses an offer from ‘Activate Your Heart’, an online cardiac rehabilitation program, that is made available on a 3-month free trial basis. In Poppy’s team they offer cardiac patients the online program, a walking program or a bespoke program devised between themselves and our qualified exercise specialist (see Figure 2). The team is also setting up formal virtual clinics for their exercise specialist so that she can see patients to discuss their exercise programs with them. Figure 2. Northern Devon Cardiac Rehabilitation Team, L–R: Lisa Pereira-Marques, cardiac rehab nurse; Roger Tithercott, retired cardiac rehab nurse; Kimberley Endacott, cardiac rehab nurse; Anita Griggs, exercise specialist; Tina Robinson, team administrator. The team feels that the different options suit different people for different reasons and shared that the ‘Activate Your Heart’ is a very holistic program. Their exercise specialist feels the exercise component of ‘Activate Your Heart’ is not enough for some people but for others it’s just right. Poppy told that while they had discussed it before the pandemic, they did not previously have any remote options. She is really pleased with how the team have embraced this and developed a comprehensive menu of remote options so quickly and not accruing a waiting list. Poppy points out that they will of course need to review outcome measures as they go along, but she suspects this has changed the delivery of their service for the longer term. For more information visit www.fibricheck.com and www.telecheck-AF.com and follow #TeleCheckAF on Twitter. For more information about ‘Active Your Heart’ visit www.activateyourheart.org.uk and follow @AYHLeicester on Twitter.