Lessons learned from the pandemic that can be translated in the future.

The Covid-19 pandemic has forced the healthcare systems across the world to reinvent themselves. This was achieved on an emergency basis, leaning on previous experience, limited hospital capacity, but mostly gut feeling. For example, remote monitoring became mandatory for the most fragile clientele such as heart failure patients, to protect them from coming to the hospital, where possible COVID-19 exposition may occur [1].

Previous experience during the H1N1 outbreak has shown a global decrease in the number of emergency department consultation, with patients presenting with very advanced disease. The same happened at the beginning of the pandemic, when there was a dramatic reduction in the number of STEMI, with more late presentation. Therefore, every effort was made to offer the best possible care to HF patients to prevent hospital admission under these difficult circumstances [2]. Hence, telemonitoring rapidly became the “new normal” to offer heart failure care, despite the lack of proven benefits of such an approach in multiple RCT conducted during “normal time, with the exception of the invasive PA monitor system [3].

In issue 38, McCambrige and colleagues [4] are reporting on their experience with heart failure management during the first wave of the COVID-19 pandemic in Ireland, compared to historical controls. They analyzed the impact of the COVID-19 pandemic on all elective and emergency hospitalisations and mortality in a HF population managed in a disease management program (DMP). They attribute those good outcomes to their clinical setting and remote monitoring (which was exclusively phone conversation as none of these patients had pulmonary artery pressure monitor nor defibrillator with impedance capacity implanted). First, they should be complimented for the intertwined structure of their healthcare system, with easy access to primary care and prompt referral to specialists care if needed, either directly or asynchronously available to GPs via a virtual consultation clinic. Actually, a majority of patients with established HF experiencing deteriorating symptoms attended either their general practitioner (GP) or a HF clinic prior to hospitalisation. This suggest that a significant proportion of patients experiencing a HF decompensation would be likely to seek care within the infrastructure provided by the DMP; this innovative model should be useful regardless of the pandemic, provide they can include a program dedicated to titration of disease modifying therapy, which has not been embedded in their COVID-19 experience.

The pandemic has markedly impacted clinical trials conducted during this dificult period for many reasons, including confinement and overloaded hospital capacity [5]. In addition, y, the recently published GUIDE-HF trial showed a marked reduction in pulmonary pressures during the pandemic for both patients in the active treatment based on pulmonary pressures and control groups, with similar reduction in HF event rates [5]. This suggests that many factors likely interplayed to explain changes in disease progression and event rates in HF patients during the COVID-19 pandemic.

Declaration of Competing Interest

The authors report no relationships that could be construed as a conflict of interest.