Changes in Care Delivery for Patients with Heart Failure During the Covid-19 Pandemic: Results of a Multicenter Survey

McIlvennan, Colleen K.; Allen, Larry A.; DeVore, Adam D.; Kaltenbach, Lisa A.; Granger, Christopher B.; Granger, Bradi B.

Introduction For patients with heart failure (HF), the impact of the COVID-19 pandemic on care delivery and access to guideline-directed therapies known to reduce morbidity and mortality is largely unknown. To better understand how COVID-19 has affected HF care, we queried clinicians across the United States participating in the CONNECT-HF clinical trial. Methods A survey was developed by expert consensus and sent to all CONNECT-HF site principal investigators. Descriptive statistics were used for the quantitative questions and content analysis was performed for free-text responses. Results Between 4/30/2020-5/13/2020, we received 83/149 responses (56% response rate), representing 83 unique HF programs from 32 states. The threshold for admitting patients to the hospital was unchanged for more than half of the respondents (n = 46/80, 57.5%). All programs experienced a decrease of in-person clinic visits (n = 82/82, 100%). A mean of 6827.9% of outpatient visits were converted to telehealth. Most programs reported routinely assessing guideline-directed medical therapy during telehealth visits (n = 70/74, 94.6%). Referrals were lower at some programs for cardiac rehabilitation (n = 49/77, 63.6%) and implantable cardioverter defibrillator (n = 17/75, 22.7%). Three themes emerged from free-text responses: 1) patients being fearful and reluctant to visit the hospital; 2) lower volume of HF admissions and inpatient census; and 3) most HF research activities have been halted. Conclusions The care of patients with HF has been impacted by COVID-19 across the United States. There is a need for further evaluation of these changes, revised guidelines and protocols for telehealth care delivery, and efforts to address patients’ fear of seeking care.