Journal of Biology and Today's World

Challenges Faced in Pediatric Cardiology during COVID Pandemic: A Review

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Introduction

COVID-19 emanated from Wuhan (China) in 2019 end. It resulted in the spread of the SARS-CoV-2 (COVID-19) pandemic. Following this, turbulence came in daily life. It also put a lot of extra burden on the health care system and financial activities across the globe [1-3]. Almost every sector, including pediatric cardiology, has been affected due to the pandemic. There has been a longing among the hospitals' management to find ways to cope with pressures of need for medical supplies and medical staff in the face of the current situation. Upon further investigation conducted by the World Health Organization, it came to light that the cause of this pneumonia belonged to a novel coronavirus family that had resulted in previous outbreaks such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

In the current situation, it is imperative to lessen face-to-face elective outpatient clinic visits for cardiology patients. However, there is an inherent challenge in this because, on the one hand, it is not wise to expose high-risk heart disease subjects to this infection. On the other hand, we have to deliver speedy care to patients on the verge of experiencing a cardiovascular event. Hence, it is a judicious decision on the part of the treating cardiologist to keep the safety of patients. As a result of the social distancing restrictions globally, there has been a profound interest in the development of telehealth services, also named telemedicine. We are of the view that such technology as telehealth can be of use in pediatric cardiology as well, keeping in view the COVID-19 pandemic. It can have a clanging impact on our daily clinical practice [4-8].

Methodology

We did search on PubMed, Medline database publications using: COVID-19, Pediatric cardiology, Telehealth, patient, pandemic, and telemedicine clinic. The publications included were special communications, reviews, conferences papers, books and research studies regarding the subject matter over last eighteen months.

Discussion

Telehealth has not been taken into practice in the provision of pediatric cardiac care in the majority of healthcare facilities. In the current situation, the pros and cons of telemedicine have been rigorously scrutinized. In the current situation, the utilization of telehealth in pediatric cardiology clinics can be of paramount value. It can help in history taking, necessary physical examination, and tests such as EKG, chest X-ray, and echocardiography, which can help in making an accurate diagnosis.

Numerous studies have described the potential role of telemedicine for the provision of extension of pediatric cardiology services to rural or distant areas without a need for an on-site pediatric cardiologist. It can be particularly of benefit for improved access to patients living in low income and distant rural areas [7-11]. Furthermore, the utilization of newer technology such as tele-echocardiography, tele-auscultation, and remote rhythm monitoring has made progress in this regard. Results regarding telemedicine utilization in pediatric cardiology are encouraging [10-15].

Additionally, telehealth has promised notable cost savings and reduction of financial strain on the healthcare system on the whole. Besides this, remote education in the form of tele-education of providers and trainees has also gained a place in this regard. However, there are still few difficulties in the implementation of telehealth such as lack of standardization of telemedicine components, involvement of unclear and complex legal issues and tedious job of licensure requirements, the complexity of insurance reimbursements, and acceptance on the part of the health care provider and patient. That’s the reason the recommendations and regulations continue to evolve [13-17].

In general, requirements for running a smooth tele health care, include a stable internet connection, proper scheduling of the time to the visit, sufficient institutional support such as a HIPAA-compliant platform, tech support, equipment, training, care maps and clinical pathways that are consistent across the program, scheduling support, and outpatient templates that accommodate telehealth. Many hospitals achieved success in the expansion of minimum required telehealth infrastructure to cope with the surge in need during the COVID-19 pandemic. They had varying policies and management pathways. Larger hospitals can afford to build the infrastructure necessary to integrate video telehealth via the Electronic Medical Record (EMR), making room for effortless access to patient data during the tele clinic visit. Moreover, patient scheduling, insurance details, and billing matters are easily tackled. Besides these, various translation features are also at hand with these platforms [15-20].

Before planning the telehealth visit of the patient, consent from the patient or parent ought to be acquired. It can be either acquired verbally or in writing. It is worth mentioning here that telemedicine can’t fit into all pediatric cardiology patients. For example, telemedicine cannot be an appropriate option in emergency scenarios, wherein the swift quick notification of emergency medical providers is in need for patient safety. However, it can help health care professionals with triaging and patient evaluation if a patient is calling from home with concerns. Video calls can assist in the rapid assessment of patient conditions that may help guide the physician regarding deciding to see a patient in the outpatient clinic in several hours or days. If a patient's condition warrants emergency care, the child can be referred and guided to present to the nearest medical center, or activating emergency medical services is more appropriate [18- 22].

Telemedicine cannot be of utility in children wherein objective information regarding the vital signs (pulse rate, oxygen saturation, blood pressure) are required. Hence, telemedicine may not be a suitable option in newborns or any child that is critically ill. Specific and meticulous examination, including subtle change in a murmur, pulse quality, or volume status may also be inadequately assessed by video, or by an examination done by a non-expert or a family member over telehealth [21-26].

Conclusion

Telehealth may prove to be a suitable alternative in times of pandemics in pediatric cardiology patients. Telehealth may also give a better idea about their situation, and environment. It can facilitate in reduction of wait times for appointments and can make room for an effective and timely triage system for in-person clinic visits.

References

1. Frederix, I., et al. “ESC e-cardiology working group position paper: Overcoming challenges in digital health implementation in cardiovascular medicine.” Eur J Prev Cardiol 26(2019):1166-1177.
2. Kurji, Z., et al. “Analysis of the health care system of Pakistan: Lessons learnt and way forward.” J Ayub Med Coll Abbottabad 28(2016):601-604.
3. Iqbal, S., et al. “Challenges faced by the patients on dialysis treatment in COVID-19 era and the possible solutions.” Biomed J Sci Tech Res 36(2021):28279-28282.
4. Syed, S.T., et al. “Traveling towards disease: Transportation barriers to health care access.” J Community Health 38.5(2013):976-993.
5. Offiah, G., et al. “The impact of a virtual cardiology outpatient clinic in the COVID-19 era.” Ir J Med Sci (2021):1-6.
6. Lopes, M.A.C.Q., et al. “Guideline of the Brazilian society of cardiology on telemedicine in cardiology.” Arq Bras Cardiol 113.5(2019):1006-1056.
7. Iqbal, S., et al. “Telemedicine in stroke clinic during the COVID era and the challenges in patient management: Review article.” J Biol Today's World 10.3(2021): 001-003.
8. Guo, T., et al. “Association of cardiovascular disease and myocardial injury with outcomes of patients hospitalized with 2019-coronavirus disease (COVID-19).” JAMA Cardiol 5.7(2020):811-818.
9. Maia, M.R., et al. “How to develop a sustainable telemedicine service? A pediatric telecardiology service 20 years on an exploratory study.” BMC Health Serv Res 19.1(2019):681.
10. Geoffroy, O., et al. “Videoconference pediatric and congenital cardiology consultations: A new application in telemedicine.” Arch Cardiovasc Dis 101.2(2008):89-93.
11. de Araújo, J.S., et al. “Impact of a Virtual clinic in a paediatric cardiology network on northeast Brazil.” Int J Telemed Appl 2015(2015):504015.
12. Singh, S., et al. “Remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study.” J Am Soc Echocardiogr 26.3(2013):221-233.
13. Mahnke, C.B., et al. “Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds.” Clin Pediatr (Phila) 47.9(2008):919-925.
14. Rothman, S.A., et al. “The diagnosis of cardiac arrhythmias: A prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring.” J Cardiovasc Electrophysiol 18.3(2007):241-247.
15. Armfield, N.R., et al. “The costs and potential savings of telemedicine for acute care neonatal consultation: Preliminary findings.” J Telemed Telecare 18.8(2012):429-433.
16. Sayani, S., et al. “Addressing cost and time barriers in chronic disease management through telemedicine: An exploratory research in select low-and middle-income countries.” Ther Adv Chronic Dis 10(2019):2040622319891587.
17. Smith, C.E., et al. “Tele-education: Linking educators with learners via distance technology. Pediatr Ann 38.10(2009):550-556.
18. Thibodeau, J.T., & Drazner, M.H. “The role of the clinical examination in patients with heart failure.” JACC Heart Fail 6.7(2018):543-551.
19. Jury, S.C., et al. “The introduction of web-based video-consultation in a paediatric acute care setting.” J Telemed Telecare 19.7(2013):383-387.
20. Harahsheh, A.S., et al. “The impact of a designated cardiology team involving telemedicine home monitoring on the care of children with single-ventricle physiology after norwood palliation.” Pediatr Cardiol 37.5(2016):899-912.
21. Mabo, P., et al. “COMPAS trial investigators: A randomized trial of long-term remote monitoring of pacemaker recipients (the COMPAS trial).” Eur Heart J 33.9(2012):1105-1111.
22. Bingler, M., et al. “Interstage outcomes in infants with single ventricle heart disease comparing home monitoring technology to three-ring binder documentation: A randomized crossover study.” World J Pediatr Congenit Heart Surg 9.3(2018):305-314.
23. Shirali, G., et al. “Harnessing Teams and technology to improve outcomes in infants with single ventricle.” Circ Cardiovasc Qual Outcomes 9.3(2016):303-311.
24. Morales, D.L.S., et al. “Third annual pediatric interagency registry for mechanical circulatory support (pedimacs) report: Preimplant characteristics and outcomes.” Ann Thorac Surg 107.4(2019):993-1004.
25. Iftikhar, M.J., et al. “Cardiology clinic in COVID-19 era-review article.” J Regen Biol Med 3.5(2021):1-6
26. Almarzooq, Z.I., et al. “Virtual learning during the COVID-19 pandemic: A disruptive technology in graduate medical education.” J Am Coll Cardiol 75.20(2020):2635-2638.