Abstract
BackgroundThe COVID-19 pandemic brought restriction to the movement of people due to the implementation of lockdown across various regions around the world. In India, most of the patients belong to rural areas and hence were unable to come for a follow-up visit. Hence, we reached out to patients on oral anticoagulation using telemedicine with aim of communicating with the patient concerning drug compliance, titration of dose of anticoagulation, health education, and identification of high-risk patients needing referral to the nearest health facility/our institute. This study was conducted at the Hero DMC heart institute (a tertiary care center for cardiac diseases). The study design is cross-sectional and involves a comparison of the pre-COVID-19 phase with the COVID-19 phase. We asked a five-component (Likert scale) questionnaire from patients for satisfaction after the consult. All symptoms, need for hospitalization and clinical events were recorded. The events were compared in both groups.ResultsWe contacted 628 patients through telemedicine and 600 patients gave consent for participation in the study. For comparison, we analyzed data of 614 patients in the pre-COVID-19 phase. The mean age during the pre-COVID-19 phase was 55.27 + 17.09 years and the COVID-19 phase was 56.97 + 15.09 years with males more than females in both groups. There was no significant difference in the number of patients on oral anticoagulants and novel oral anticoagulants (NOAC). However, there were higher number of patients on antiplatelets in the pre-COVID phase (p value0.01). 37% in the pre-COVID-19 phase and 40.31 % in the COVID-19 phase were noted to have out of target range INR (International normalized ratio). There was no difference in the number of bleeding or thromboembolic events seen. Patient response as assessed by a questionnaire (Likert scale) showed that >75% of patients were satisfied.ConclusionThrough telemedicine, we were able to approach our patients on oral anticoagulation and achieved titration of anti-coagulation, and health education similar to pre-COVID-19 times. During pandemics, telemedicine offers a promising option for patient management with chronic cardiac conditions. It also provides us an opportunity for the management of patients on oral anticoagulation involving titration of drug dosages (anti-coagulation), identification of high-risk patients, and health education.
Highlights
The COVID-19 pandemic brought restriction to the movement of people due to the implementation of lockdown across various regions around the world
One of the major tasks for a tertiary care center in northern India catering to the health needs of millions of patient population was to outreach the patients through telemedicine [1, 2]
Both groups had a similar number of patients with hypertension, diabetes, and coronary artery disease; the number of patients on antiplatelets was higher during the preCOVID-19 phase as compared to the COVID-19 phase
Summary
The COVID-19 pandemic brought restriction to the movement of people due to the implementation of lockdown across various regions around the world. One of the major tasks for a tertiary care center in northern India catering to the health needs of millions of patient population was to outreach the patients through telemedicine [1, 2]. India, being a state of diverse educational, medical, and living conditions, self-monitoring [6] is not easy to achieve especially in rural populations. We took this opportunity to educate our cardiac patient population about the spread of COVID-19 and precautions to be followed. We aimed to compare the effectiveness of the management of patients on oral anticoagulants through telemedicine during the COVID-19 phase versus the pre-COVID-19 phase
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