Abstract
The past year challenged patients, health care providers, and health systems alike to adapt and recalibrate to meet healthcare needs within pandemic constraints. The coronavirus 2019 (COVID-19) pandemic has radically interfered with the accessibility and delivery of cardiovascular care in the United States. With an emphasis on social distancing and stay-at-home orders in effect, many Americans delayed seeking routine medical care and treatment for acute cardiac symptoms due to fear of contracting the coronavirus. The COVID-19 pandemic compelled a rapid shift toward virtual care solutions across cardiovascular domains. The U.S Department of Veterans Affairs (VA) expanded virtual modalities, notably in specialty care and rehabilitation, which offered secure solutions to maintain treatment continuity. Within the VA and other health systems, virtual cardiac rehabilitation (CR) was embraced as an efficacious alternative to on-site cardiac rehabilitation that enabled patients to receive cardiac care remotely. Leveraging the infrastructure and lessons learned from the pandemic-induced expansion of virtual care carries enormous potential to refine virtual CR and revitalize future treatment paradigms for cardiovascular disease patients.
Highlights
The U.S Department of Veterans Affairs (VA) is the nation’s largest healthcare system serving more than 9 million Veterans across 170 hospitals and over 100 outpatient facilities
This paper aims to review this collective experience from the dramatic expansion of virtual cardiac services during the COVID-19 pandemic and to make recommendations for clinicians and hospital leaders to sustain these practices for future viability
While focused on Veterans in remote and rural areas, VA’s prior investment in technology, human resources, and policy related to telehealth provided a firm foundation for the rapid and widespread acceleration of virtual cardiac services, such as virtual cardiac rehabilitation (CR), that COVID-19 demanded
Summary
As the coronavirus 2019 (COVID-19) pandemic spread through the U.S in early 2020, the VA began deferring routine care and elective procedures alongside an unprecedented national shift towards virtual care [1]. This transition was especially pervasive within the cardiovascular care continuum, as postponed interventions and decreased acute care hospitalizations early in the pandemic gave way to extended delays in preventive and routine outpatient cardiac care (Figure 1) [2]. As an early adopter of telehealth programs beginning in the 1990s, the VA had existing bandwidth to expand virtual care offerings, yet most of the available virtual care capacity was centered within the primary care and behavioral health service lines at the start of 2020. The uptick in virtual care utilization within the Veteran population can be stratified and examined across various demographics and populations
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