Treating patients during a pandemic: 3 key ways COVID-19 changed cardiovascular care
The COVID-19 pandemic led to significant changes in patient care in 2020, and the impact of those changes will likely be felt for years to come. A research team out of Los Angeles explored the pandemic’s effect on all remote and in-person ambulatory cardiology visits at a large health system, sharing its findings in JAMA Network Open.
“It remains unknown how this large-scale transition to remote care in the real world has changed clinical practice patterns in cardiology both in terms of the patients who are able to access care as well as the type and quality of care that is being delivered,” wrote Neal Yuan, MD, of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, and colleagues. “As there is currently a paucity of formal guidelines specifying best practices for remote cardiology visits, there may be unintended consequences from this new form of care that have yet to be identified.”
To learn more, Yuan et al. compared data from April to December in 2019, before the pandemic was in full swing, with data from April to December in 2020. All data came from cardiology clinic patient visits.
There were more than 87,000 in-person visits in 2019. In 2020, during the pandemic, there were more than 74,000 in-person visits, more than 4,500 video visits and more than 10,000 telephone visits.
According to the team’s assessment, the three most notable changes to patient care in 2020 were:
1. Remote care was used more frequently by almost all patient groups.
As is to be expected, many patients were more likely to use virtual care during the pandemic than before it. This was true for patients who were Asian, Black, Hispanic, had private insurance coverage or had cardiovascular comorbidities such as hypertension or coronary artery disease.
2. Medications were prescribed less frequently.
“When comparing ordering practices between pre-COVID in-person, COVID-era in-person, COVID-era video, and COVID-era telephone visits, we found a decrease in the proportion of visits where at least one medication was ordered,” the authors wrote. “The proportion of visits where at least one medication was prescribed decreased from more than two-thirds of pre-COVID in-person visits to half of COVID-era in-person visits to only one-third of COVID-era video visits and one-quarter of COVID-era telephone visits.”
When COVID-19 daily numbers were down, the team added, it seemed that medications were often ordered more regularly.
3. Diagnostic tests were ordered less frequently.
Researchers observed the same trend when it came to ordering diagnostic and laboratory tests. Again, as it was with prescribing medications, daily COVID-19 numbers appeared to play a large role in this shift.
“It could be argued that the observed decreases in testing and prescribing were because clinicians were initially waiting for the COVID-19 pandemic to subside before advancing medical care,” the authors wrote. “Across all visits, we found that ordering practices appeared to change in association with the severity of the local COVID-19 case incidence, but we found that the differences between in-person, video, and telephone visits persisted across nearly every month of the nine-month period of study.”
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.