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      Letter to the Editor: Pulmonary Artery Pressure Monitoring during the COVID-19 Pandemic in New York City

      , MD MSc, , MD, , MD, , MD, , MD *

      Journal of Cardiac Failure

      Elsevier Inc.

      Telemedicine, Heart failure, COVID-19

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          To the Editor Almufleh. et al 1 describe the impact of the Coronavirus disease 2019 (COVID-19) pandemic on 21 patients with heart failure (HF) monitored with the implantable CardioMEMS-3 system in Massachusetts before and after March 11th 2020 when a state of emergency was declared. Pulmonary artery pressure (PAP) volatility in the post COVID-19 period increased, with higher frequency of patients crossing pulmonary artery diastolic (PAD) thresholds, but concomitant increase in clinician calls and interventions and a reduction in HF hospitalizations. The authors conclude that effective remote monitoring management was at least partly at play in preventing hospital admissions in this small cohort. We also conducted a retrospective chart and remote monitoring review of 49 patients with wireless implantable hemodynamic monitoring (W-IHM), of whom 40 were actively followed at our institution from February 1st to April 22nd (pre-COVID-19 and during COVID-19 period) in New York. The first confirmed case of COVID-19 in New York State (NYS) was on March 1st. On March 22nd, the “NYS on Pause Program” went into effect with a statewide stay-at-home mandate including closure of non-essential businesses. It was during this time that NYS was the global epicenter of the COVID-19 pandemic. As of July 15, 2020, 404,775 patients tested positive for COVID-19 in New York State (NYS) which represented the highest number of cases in the United States at that time. 2 We similarly aimed to ascertain whether stay-at-home mandates would result in changes in pulmonary artery diastolic pressures among patients with HF and W-IHM. In our larger cohort, we made the following observations: 1) the rate of W-IHM transmissions by patients increased as did the number of interventions by clinicians (phone calls, text messages and video encounters) during the pandemic; 2) there was no significant difference in the mean PADP prior to and during COVID-19 (19.4 ± 5.6 mmHg and 18.9 ± 6.7 mmHg (p = 0.654) respectively), nor was there a difference in the mean HR (79.9 ± 14.4 vs. 78.9 ± 15.3 bpm (p = 0.8105) respectively) (Figure 1 ); 3) the number of HF hospitalizations was lower during the pandemic. Figure 1 (A & B) Trends in Average Pulmonary Artery Diastolic Pressure and Heart Rate: Pre- COVID-19 (February1, 2020 to February 29, 2020) and during COVID-19 (March 22, 2020 to April 22, 2020. Figure 1 Patients transmitted readings an average of 17.8 ± 9.1 times per month in the period pre-COVID 19 compared to 18.9 ± 9.9 times per month during COVID-19 (p=0.526). During the latter period, individuals had a range of 0 to 4 interventions in a month, and of those, 13 (32.5%) had an increase in diuretics, 8 (20%) had a decrease in diuretics, and 1 (2.5%) had a change in guideline directed medical therapy. Similarly, during COVID-19, individuals had a range of 0 to 5 interventions in a month, and of those, 16 (40%) had an increase in diuretics, 7 (17.5%) had a decrease in diuretics, and 1 (2.5%) had a change in guideline directed medical therapy. Our study has similar limitations to those reported by Almufleh et al, in that generalizability is limited due to the small cohort size and retrospective study design. Behavioral changes as a result of home isolation during the COVID-19 pandemic may be bidirectional. Increased anxiety may drive poor dietary choices. Conversely, a reduction in daily activity may decrease autonomic tone and result in increased medication compliance, daily weight monitoring and transmission of PAP via W-IHM. As COVID-19 continues to spread and result in morbidity and mortality, reliance on remote monitoring is likely to increase. We agree with Almufleh et al that vigilant monitoring, and in particular management of remote monitoring devices, may at least in part explain the decrease in HF hospitalizations despite patient reluctance to seek medical care; however, we failed to find the initial PAP volatility reported in Boston. More reports are needed to determine the effects of social changes inflicted by COVID-19 restrictions on congestion, compliance and outcomes among patients with HF and W-IHM.

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          Author and article information

          J Card Fail
          J. Card. Fail
          Journal of Cardiac Failure
          Elsevier Inc.
          14 August 2020
          14 August 2020
          Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
          Author notes
          [* ]Corresponding Author: Anuradha Lala, MD, Zena and Michael A. Wiener Cardiovascular Institute, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave 1 Levy Place, Box 1030, New York, NY, 10129; Phone: 212-241-7300 anu.lala@ 123456mountsinai.org
          © 2020 Elsevier Inc. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.


          Pharmacology & Pharmaceutical medicine

          telemedicine, heart failure, covid-19


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