Preparing cardiovascular care delivery for the post-COVID world

Demand for cardiovascular care was on the rise before COVID-19, thanks to an aging population and increased access to care.

But COVID-19 has created complications resulting in increased demand for cardiovascular care.

During a Becker's Healthcare Cardiology Virtual Forum session sponsored by ECG Management Consultants, three ECG panelists discussed trends and associated clinical imperatives:

  • Morgan Leske, manager of strategy and business advisory
  • Terri McDonald, RN, associate principal for performance transformation
  • Sara Turley, manager of performance transformation

Key takeaways were:

1. COVID-19 has caused cardiovascular complications and led to new guidelines. Myocarditis, tachycardia, exercise intolerance, chest pain, palpitations, shortness of breath and heart failure are all consequences of COVID-19. "A growing number of studies suggest many COVID-19 survivors experience some type of heart damage, even if they didn't have underlying heart disease," Ms. McDonald said, citing a publication from the American Heart Association. Other data mentioned included a September 2021 CDC study which found a 42 percent increase in myocarditis diagnosis in 2020 compared to 2019 and another study showing that 44 percent of patients with COVID-19 admitted to the ICU were experiencing heart palpitations.

"It became apparent fairly early on that the virus can severely damage the heart as one of its worst complications," Ms. McDonald said. "And then we started to see more subtle manifestations," especially in the post-acute phase of "long COVID." That led the American College of Cardiology (ACC) to issue new clinical guidelines in the form of an Expert Consensus Decision Pathway.

2. Clinical complications from COVID-19 are leading to several trends in cardiovascular care delivery and imperatives for program leaders. Six key trends are:

  • Increasing volumes and demand for cardiovascular care. The demand for cardiovascular care was on the rise even before the pandemic," Ms. Turley said. Practice leaders must expand patient access and capacity efficiently. They must also focus on optimizing workflows and maximizing clinician time.
  • New long-COVID clinics. Long-COVID clinics are used to evaluate complications. Many healthcare systems have been establishing long-COVID clinics, including within existing cardiovascular departments.
  • Focused cardiac imaging. Health systems are seeing rising demand for focused cardiac imaging. Leaders must prepare for an influx of cardiac imaging across multiple modalities.
  • More same-day discharges. During the pandemic, expedited discharges minimized the chance of patient exposure. Same-day discharges are being continued. "Health systems and providers have implemented new protocols to discharge cardiac procedural patients within the same day," Ms. Leske said, including for devices, ablations and TAVR, to reduce the risk of COVID exposure.
  • Sustained use of telehealth services. Telehealth use has exploded. "It's been proven to be safe, effective and convenient for patients and providers," Ms. Leske said. For practice leaders, imperatives now include expanding the digital front door and investing in new clinical technology and wearables to bring down costs.
  • Clinician burnout and workforce shortages. Burnout among cardiovascular providers nearly doubled during the pandemic. Factors contributing to burnout include too many bureaucratic tasks, lack of respect, long hours, lack of autonomy and stress. Imperatives for practice leaders include implementing programs to reduce stress and burnout. "Without our providers, nothing works," Ms. McDonald said. One way to reduce stress is to shift non-clinical burdens from providers and to use all clinical staff to the top of their licensure.

It remains unknown whether cardiovascular problems brought about by COVID will resolve over time for most people, or whether they will be persistent health problems. But with the potential for increased cardiovascular risk across broad sections of the U.S. population, health systems and providers need to plan today for future cardiac care capacity.

To learn more about Becker's virtual events, click here.

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