Challenges to cardiac healthcare professionals
Healthcare professionals need to stay updated constantly and adapt their advice to patients and also change their own professional and private behaviour. Some of our colleagues need to stay at home because of social distance restrictions on family members, COVID-19 symptoms, preventive quarantine or mental stress. Some colleagues are afraid to go to work in case of endangering themselves or their family.
A substantial number of professionals working in the departments of cardiology and cardiothoracic surgery are preparing to alter (have already altered) their daily clinical work, some have experienced having their ward rebuilt to be suitable for COVID-19 patients, some wards have closed completely to relocate staff to other acute care units. Staff are educated to take care of other patient groups than they usually treat (and have expertise in). ICUs are reorganised and rebuilt to the maximum of respiratory beds. Healthcare providers from medical, cardiology and cardiothoracic ICUs create large teams that can work across ICU COVID-19 units with similar equipment and protocols.
In a lot of cardiology out-patient clinics, obvious changes include moving to distance follow-up instead of a clinic visit and also extending the length of follow-up phone calls, since many patients want to talk about COVID-19 and what it means to them. In some hospitals, the pacemaker control period is extended from bi- or tri-monthly to yearly, most angiograms and electrophysiology procedures are cancelled. ICDs are monitored using tele-monitoring systems, preventing patients from coming to hospital after receiving a shock therapy and reassuring them by telephone. It is amazing how quickly telecare and distance monitoring have become almost ‘the new normal’ and how flexible patient and healthcare professionals are in adopting these practices.1
However, specific challenges of distance follow-up have also become painfully clear and need creative solutions.2 For example, it is more difficult to estimate whether a newly referred patient or his or her family can recognise signs and symptoms, such as leg oedema in heart failure patients, or whether they are able to decide if it is necessary to come to the hospital. In addition, in patients with visual or auditory impairments, it can be difficult to change medication by phone, especially when a patient does not have email or cannot read very well. For patients who are very lonely and feel socially isolated, and/or elderly patients, extra telephone contact with the clinic can be very important to ask questions and help to solve problems.
Uptitration of medication can be complicated without appropriate laboratory tests or physical examination of a patient. Every time one orders a laboratory test (at home or in an office) one has to balance the risk of exposing the patient to possible COVID-19 infection (or the healthcare professional in taking the blood) yet really needing the laboratory value to adapt medication, for example to make that last step in an uptitration schedule.