key: cord-0990532-l91pw0sl
authors: D’Amario, Domenico; Restivo, A; Canonico, F; Rodolico, D; Galli, M; Burzotta, F; Vergallo, R; Trani, C; Aspromonte, N; Crea, Filippo
title: Experience of Remote Cardiac Care during Covid‐19 Pandemic: the V‐LAP™ device in advanced heart failure
date: 2020-05-19
journal: Eur J Heart Fail
DOI: 10.1002/ejhf.1900
sha: c13255c7bc3d6e907752b7b34566a0df69280073
doc_id: 990532
cord_uid: l91pw0sl

nan

The outbreak of Coronavirus disease-2019 (COVID-19) has imposed disruptive changes in cardiovascular care worldwide (1) . During the pandemic, allocating resources and mitigating risks have been puzzling processes, requiring extensive adaptations of inpatient and outpatient services. While a dramatic rise of cases has led to overwhelming hospital admissions, heart failure (HF) remained a challenging scenario, since it could overlap in clinical presentation with COVID-19 infection.

Therefore, the usual modalities of care delivery for HF patients have been implemented, favoring preventive measures, minimizing in-person contacts, reducing patient and health care providers risk of exposure.

This unprecedented scenario has accelerated the transition toward telemedicine as a way to provide safe, accountable, and effective care in HF. It is worthy to mention that HF is highly prevalent, especially among the elderly population, the most at risk for the worst outcomes with COVID-19: interatrial device captures left atrial pressure. The measurements are daily collected by means of an external belt, sending data to the cardiologist via a cloud-based system. In our center, two patients have been enrolled so far. Here we present the first case with the longer follow-up. The V-LAP™ System was implanted in a 75 years old patient with HF with severely reduced EF (LVEF=25%), NYHA class III, and frequent HF-related hospitalizations (2 in the previous 6 months). After 90 days, the right heart catheterization confirmed the accuracy of LAP measurements as compared to pulmonary capillary wedge pressure. Once the reliability was confirmed, LAP trends have been monitored and used to guide the optimization of medical therapy (Figure 1 ).

During the course of COVID-19 Italian pandemic, the V-LAP system showed remarkable reliability and easiness of use, encouraging patients to adhere with a high compliance rate (>99%) to the protocol.

The remote analysis of the LAP curves led to earlier detection of underlying disease progression preventing clinically relevant decompensation: when a rise in mean LAP was observed, diuretictherapy was modified accordingly. No hospital readmissions occurred over 6 months, avoiding medical contacts and in-hospital exposure. NYHA functional class improved (from III to II) and was coupled with an amelioration of the perceived quality of life, evaluated with the Kansas City Cardiomyopathy Questionnaire. Similar results were obtained in the second case implanted.

In the first-in-human cases, the implantation of the V-LAP™ was feasible, safe, and showed good accuracy and precision. While further data are needed, HF patient management guided by the V-LAP system has the potential to significantly improve patient outcomes and also to decrease direct and indirect costs: the paucity of healthcare resources under the pandemic has highlighted the importance of safer and clinically appropriate solutions of remote telemonitoring, paving the way of a widened use of similar means.

The COVID-19 pandemic has fostered the virtuous cycle of pre-clinical and clinical research, providing effective answers to the pressure of highly demanding therapeutic needs. Enduring

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Disruptive Modifications to Cardiac Critical Care Delivery During the Covid-19 Pandemic: An International Perspective

Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure

COVID-19 Illness and Heart Failure: A Missing Link? JACC: Heart Failure

advancements have been stimulated, and the benefits will last beyond the course of the outbreak. As telemedicine continues to flourish and to be applied even in ordinary settings, the words attributed to the late Albert Einstein seem appropriate: "All crises bring progress. Creativity is born from anguish, just like the day is born form the dark night. It is in crisis that inventiveness is born, as well as discoveries made and big strategies."

This article is protected by copyright. All rights reserved.

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