Impact of Telemedicine on Pediatric Heart Transplant Patients during the COVID-19 Pandemic

Abstract

PurposeDuring the COVID surge and shutdown (SD) of NYC from 3/20-5/20, we transitioned to telemedicine (TM) to provide routine and urgent care to our pediatric heart transplant (HT) patients (pts). The effectiveness of TM in this population has not been described.MethodsA retrospective cohort study was conducted at the Children's Hospital at Montefiore, Bronx, NY. Electronic health records of all HT pts who received care from 1/3/20-8/31/20 were queried. Data collected included frequency of TM, in person, and emergency room (ER) visits, hospitalizations, immunosuppression (IS) levels requiring adjustment, and out-of-window pt follow-up (f/u). The proportion of IS levels out of range was compared among 4 groups by chi-square analysis.ResultsDuring SD there were 54 TM visits: 61% routine and 39% sick. Five (24%) sick TM visits justified an in person f/u: 3 clinic visits, 2 ER visits, 1 required hospitalization (Figure). During the post-SD period 1 when in person visits resumed, 9 pt visits were out of window for routine f/u, median of 6 weeks delayed. IS levels were not therapeutic in 29% of pts pre-SD compared to 46% during post-SD period 1 (p=0.06). There was a difference between post-SD period 1 and 2 (p=0.04). By SD period 2, IS had returned to pre-SD levels (p=0.6) (Table).ConclusionTM can be utilized to stay connected to pts and reduce the need for in person visits when routine in person care is disrupted. The higher percentage of pts with IS levels out of range seen during the immediate post COVID SD period reinforces the importance of routine IS level surveillance. Home IS level monitoring should be considered as a component of TM in this population.