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Effects of COVID-19 pandemic on the management of pulmonary hypertension - 30/12/22

Doi : 10.1016/j.rmed.2022.107061 
Christine Y. Zhou a, Sandeep Sahay b, Oksana Shlobin c, Francisco J. Soto d, Stephen C. Mathai e, Lana Melendres-Groves f, Christopher J. Mullin g, Deborah J. Levine h, Dana Kay i, Kristin Highland j, Eduardo Bossone k, Abby Poms l, Humna Memon m, Vijay Balasubramanian n, Mary Jo S. Farmer o, Franck Rahaghi p, Jean M. Elwing i,
a Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA 
b Division of Pulmonary, Critical Care & Sleep Medicine, Houston Methodist Hospital, Houston, TX, USA 
c Pulmonary Hypertension Program, Inova Fairfax Hospital, Fairfax, VA, USA 
d Division of Pulmonary & Critical Care Medicine, University of Tennessee Medical Center, Knoxville, TN, USA 
e Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA 
f Division of Pulmonary & Critical Care Medicine, University of New Mexico Health Science Center, Albuquerque, NM, USA 
g Division of Pulmonary & Critical Care Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA 
h Division of Pulmonary & Critical Care Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA 
i Division of Pulmonary & Critical Care, University of Cincinnati, Cincinnati, OH, USA 
j Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA 
k Division of Cardiology, A. Cardarelli Hospital, Naples, Italy 
l Poms Research Consultants, USA 
m Division of Pulmonary & Critical Care, Spectrum Health Hospital, Grand Rapids, MI, USA 
n Division of Pulmonary & Critical Care Medicine, UCSF Fresno, Fresno, CA, USA 
o Division of Pulmonary & Critical Care, UMass Chan Medical School Baystate, Springfield, MA, USA 
p Department of Pulmonary Medicine, Cleveland Clinic Florida, Weston, FL, USA 

Corresponding author. University of Cincinnati, 231 Albert Sabin Way, ML 0564, Cincinnati, OH 45267, USA.University of Cincinnati231 Albert Sabin WayML 0564CincinnatiOH45267USA

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Abstract

The coronavirus of 2019 (COVID-19) disrupted delivery of healthcare. Patients with pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), require significant resources for both diagnosis and management and are at high risk for decompensation due to disruption in their care. A survey consisting of 47 questions related to the care of patients with PH was designed by the American College of Chest Physicians 2020–2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee and sent to all members of the PVD NetWork, as well as the multiple other professional networks for PH. Participation was voluntary and anonymous. Responses were collected from November 2020 through February 2021. Ninety-five providers responded to this survey. The majority (93%) believe that care of PH patients has been affected by the pandemic. Sixty-seven percent observed decreased referrals for PH evaluation. Prior to the pandemic, only 15% used telemedicine for management of PH patients compared to 84% during the pandemic. Telemedicine was used most for follow up of selected low-risk patients (49%). While 22% respondents were completely willing to prescribe new PAH therapy via telemedicine, 11% respondents were completely unwilling. Comfort levels differed based on type of medication being prescribed. Over 90% of providers experienced disruptions in obtaining testing and 31% experienced disruptions in renewal or approval of medications. Overall, providers perceived that the COVID-19 pandemic caused significant disruption of care for PH patients. Telemedicine utilization increased but was used mostly in low-risk patients. Some providers had a decreased level of comfort prescribing PAH therapy via telemedicine encounters.

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Keywords : Pulmonary hypertension, Pulmonary arterial hypertension, COVID-19 pandemic, Practice patterns


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Vol 206

Article 107061- janvier 2023 Retour au numéro
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