COVID-19 took the world somewhat by surprise. In some geographies, public health bodies were either non-existent or non-functional. Countries had to quickly develop strategies for mass testing, contact tracing, isolation and quarantine protocols. Looking back at the past 18 months, we can take pride in the pace of adaptation, collaborations and speed of innovations.
Almost overnight, health systems had to re-evaluate the priorities. We learned new terms such as ‘flattening the curve’, ‘PPE’, ‘epidemic vs pandemic’ and ‘quarantine’. As providers converged their efforts and resources on COVID-19-related activities, routine care had to be suspended and outpatient clinics were closed.
It is important to consider that cardiovascular disease remains the most common cause of death globally and accounts for more than 17.8 million deaths annually. Of concern, there was an alarming reduction in healthcare-seeking behaviors in patients during the enforced lockdown period to contain the viral spread.
The pandemic compromised the delivery of acute care across the breadth of cardiology. As most of the elective procedures and screenings were put on hold, understandably a massive backlog built up. Ironically, the very measures designed to flatten the curve for COVID-19 infection, caused increased pressure on every other healthcare service trying to maintain a degree of ‘normal’ service. These efforts are further affected by social distancing regulations, resource constraints and new requirements for infection screening and control.
Digital health initiatives
Generally, the health systems that have coped better have benefited from the maturity of their digital health assets. Their access to accurate data enabled better planning and targeted interventions. Remote monitoring of quarantined patients, a mobile application for testing and vaccination statuses, and other interventions have been instrumental in mounting an effective response to the pandemic. It's only natural that we look at e-health solutions to support our efforts to catch up on elective care.
With the increased pressure on resources caused by the pandemic, health systems will need to strategize to create digitally enabled processes to address chronic conditions like cardiovascular diseases.
The strategy has to be built around the efficient use of resources and care that is both patient-empowered and patient-centric. In an EHR-enabled healthcare world we, fortunately, have access to a wealth of data that we can use to efficiently plan. By combining digital health technology with data-rich insights and smart processes/workflow, there is a huge possibility to bring the balance back to managing chronic patients effectively.
Patient-centric approach: care coordination based on risk stratification
Care coordination has a huge potential to bring efficiency in managing cardiovascular patients in health systems. With the availability of patient data, we now have the opportunity to utilize AI and machine learning to aid in the risk stratification of patients. These methodologies not only have the potential to provide insights to clinicians on the high-risk patients’ cohort, but also can provide them with decision support for patients’ medication management, like reducing statin therapy in low-risk patients.
EHR solutions are equipped today with efficient tools to provide care coordinators with a rich clinical decision support experience in proactively managing patients.
EHR tools like registries or worklists are capable of providing clinical insights and CDS support, such as guiding clinicians in suggested care pathways that would be applicable for a patient based on multiple risk parameters and risk stratification category. These tools can provide them additional information like patient compliance to cardiovascular care protocols, medication adherence, early detection of patient deterioration, identification of high-risk patients and guiding them to secondary care services to prevent any adverse events, etc.
Care coordinators can act as a linchpin between healthcare services and patients, understanding their needs in greater depth and giving them proactive care. This approach can help them stay one step ahead of traditional routine care by providing patients proactive care and managing their conditions effectively, reducing the burden on the health system by minimizing emergency care or inpatient visits1.
Telehealth and remote care monitoring for cardiovascular patients
Virtual care became a norm during the pandemic, as health systems had to rely on e-clinics/video visits to ensure the availability of healthcare services to patients while also reducing patients' visits to clinics/hospitals. It opened a new spectrum of possibilities to manage patients. Patients with chronic conditions are more cautious about visiting hospitals due to COVID concerns, but the possibility of patients dying from an unmonitored and untreated cardiac condition is high. There are wearables available today, like watches and ECG devices, that can help in diagnosing atrial fibrillation (AFib), ventricular tachycardia and other cardiac arrhythmias. These devices can be administered via telehealth and results can be monitored in real time.
Identifying, activating a protocol for monitoring patients based on risk stratification and real-time data can reduce adverse events and burden on health systems.
Patient empowerment and education
Patient empowerment is a new paradigm for improving health outcomes by providing patients with greater control over their own health and shared decision making with healthcare providers. Patients can only be empowered by their healthcare provider through constant medical feedback and education, which will slowly transition the patient to be more confident in their self-care and responsibility. With telehealth utilization on the rise, it is imperative to continue to ensure the connection to healthcare providers, as there could be a natural feel of disconnect in the virtual world.
Patient education, patient and provider willingness, and motivation are key factors that help build a relationship where the patient is effectively contributing to their own care and decision making.
Empowered patients are an important element in transitioning healthcare from reactive to prevention and wellness. There is a tremendous opportunity for patient engagement applications like patient portals embedded with tools to review patient problems and communicate goals in self-care, especially for cardiovascular patients who need to improve their quality of life and make changes in lifestyle, such as smoking cessation, nutrition, medication adherence, etc2.
1Machine learning-aided risk stratification system for the prediction of coronary artery disease - PubMed (nih.gov)
2The Patient’s Voice | Patient Empowerment: Through the Eyes of Doctor and Patient - American College of Cardiology (acc.org)
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