Changes in the pattern of heart failure and diuresis clinic utilization during the COVID-19 pandemic.

To the Editor:

The overall structure of healthcare delivery has changed in response to the coronavirus disease 2019 (COVID-19). Besides the impact of COVID-19 on those diagnosed with the virus, it has also greatly affected patients with chronic cardiovascular illnesses that require routine visits for health maintenance. Heart failure (HF) patients need close monitoring with frequent visits to HF clinics, and at times urgent visits resulting in intravenous (IV) therapy in the ambulatory setting.

On March 14th, after the Georgia state Governor announced a COVID-19 state of emergency, there has been a decline in weekly HF hospitalizations. Here we report on the changes in HF weekly outpatient and diuresis clinic visits at the Northeast Georgia Health System (Fig. 1 ). The data were collected from Jan 11th to July 3rd, 2020. The mean (±SD) weekly visits to the diuresis clinic were 3.82 ± 1.89 from Jan 11th to Mar 27th, 1.25 ± 0.5 from Mar 21st to Apr 17th, and 4.00 ± 1.7 from Apr 18th to July 3rd. In terms of the ratios between visits to the diuresis clinic and visits to HF clinics, the numbers from Jan 11th to Mar 27th, Mar 21st to Apr 17th, and Apr 18th to July 3rd were 3%, 1%, and 3%, respectively. The decrease in patients at the diuresis clinic was more pronounced than the reduction in the scheduled regular HF visits during Mar 21st to Apr 17th. The numbers of visits to diuresis clinic returned to historical values immediately after reopening on Apr 24th and were maintained thereafter. No surge in visits to diuresis clinic was observed, despite the “diuresis clinic debt” incurred during the Public Health State of Emergency and Shelter-in-Place periods.

Fig. 1

Pattern of weekly HF visits and patients at outpatient diuresis clinic at Northeast Georgia Health System from Jan 11st to July 3rd, 2020.

During the time of Shelter-In-Place order, many patients rescheduled their appointments to a later date which could explain the lowered number of visits at that time. Some patients chose to receive clinical services via telehealth, but concerns were raised in terms of the effectiveness of virtual physical exams and the limitation of obtaining laboratory checks potentially reducing medication titrations. The decline in visits observed at our diuresis clinic is concerning as there may be decompensated patients staying at home and delaying their care. Alternatively, there may be improved adherence to medical therapy leading to reduced episodes of acute HF and need for visits to the diuresis clinic.

With COVID-19 cases on the rise, health care systems need to be prepared for changing patterns of resources utilization by patients. Whether there will be a “rebound” effect with a surge in outpatient HF visits or need for IV diuresis amid this rise in COVID-19 cases remains to be seen. Furthermore, the long-term impact of delayed or deferred HF care are unclear.

Declaration of Competing Interest

Dr. Egolum consults/advisory board for Akcea Theraputics, Alnylam, AstraZeneca and Pfizer. The remaining authors have nothing to disclose.