The Utility of Televisits in Patients with Cardiac Amyloidosis during the COVID-19 Pandemic

Slomovich, S.; Fried, J. A.; Clerkin, K. J.; Raikhelkar, J.; Maurer, M. S.; Kim, A. J.; Sayer, G.; Uriel, N.; Griffin, J. M.

Purpose In the era of COVID-19, the televisit has become a critical means of providing healthcare for patients unable to attend in-person visits. Transthyretin and light chain amyloidosis are complex diseases, that require frequent and close follow up. The aim of this study was to assess the utility and effectiveness of televisit encounters for patients with cardiac amyloidosis (CA) during the COVID-19 pandemic. Methods This was a prospective cohort study of consecutive patients with CA who were evaluated by televisit between March and May, 2020, at a large academic medical center. Patient demographics, baseline medications and details of televisit encounters were collected from electronic medical records. Patients were followed for 3 months from their first televisit for medication changes, in-person clinic visits, hospital admissions, and mortality. Results Ninety-eight patients with CA were included. Mean age was 76.5±9.1 yrs and 79 were male (80.6%). The number of televisits per patient is shown in Figure 1a. Over 3-months follow-up, 26 patients (26.5%) were seen for either an in-person clinic visit or right heart catheterization. There were 7 emergency room visits, of which 4 (4.1%) resulted in hospital admission, 1 patient (1.0%) had multiple admissions and no patient died (Figure 1b). None of the hospital admissions occurred within two weeks of a televisit. Hospital admissions were due to heart failure exacerbation, sepsis, acute kidney injury and dehydration secondary to diarrhea. During follow-up, 23 patients (23.5%) had medication adjustments, most commonly changes in diuretic (56.5%) and mineralocorticoid receptor antagonist (56.5%) doses. Two patients were newly initiated on tafamidis, for treatment of transthyretin CA. Conclusion The use of televisits for the management of patients with CA is feasible, and the low admission rate indicates that televisits are a safe and effective way to manage CA patients in the outpatient setting.