Virtual Follow-up
With the COVID‐19 pandemic, LVAD supported patients, their close
caregivers and the healthcare professionals face some completely
unprecedented and unexpected challenges that may affect their ability to
maintain optimal self‐care. Accesses to the hospital should be
discouraged to reduce the risk of hospital‐acquired infection. Thus,
monitoring of regular function of the device, laboratory tests, and
clinical evaluation may be postponed or made less frequent.
Most LVAD centres have adapted their face to face contacts by organizing
remote patient care with virtual or telephone contacts. Each LVAD
recipient can be considered for a telemonitoring algorithm after an
initial check of his/her status through a phone call to check the
home‐care situation, recent or current hospital admissions, and open
clinical problems requiring regular access to the referring clinic such
as in case of severe driveline infections undergoing specific
treatments. Patients entering this monitoring programme should have been
judged as adequately educated through extensive talks and training
sessions with the VAD coordinator focused on driveline dressing
techniques, battery and controller exchange, blood pressure, fluids, and
anticoagulation self‐management.
Through virtual visits, HF clinicians can maintain face-to-face
interactions with their patients, gain familiarity with patients’
domestic circumstances, obtain vital sign measurement through home blood
pressure cuffs and pulse oximeters, perform limited physical
examinations for jugular venous distention, peripheral oedema and
driveline site integrity, functional capacity, resolve medication issues
and interact with caregivers. Patients can send a picture of the
driveline site through email or smartphone.
Assessment provided with a virtual visit can also include evaluation of
LVAD controller parameters and screening for adverse events, in addition
to counselling.[34] Since prevention is currently the best strategy
for COVID‐19, home management requires that healthcare professionals
innovate ways to follow LVAD patients virtually and advise them with
instructions to self‐quarantine, take hygiene actions and social
distancing measures for prevention of disease and transmission.
Healthcare professionals should limit all elective medical visits and
testing, arrange for in‐home blood-testing and home international
normalized ratio monitoring as well as emphasize the importance of
nutrition, sleep and exercise. Patients’ families and caregivers must
also be protected and practice self‐care measures for safety. Delivering
optimal support to LVAD implanted patients during the COVID‐19 pandemic
include creating local support networks to deliver educational
materials, extra pro‐active phone calls from the VAD coordinator.
Those with limited access to the internet and/or “smart” devices may
not derive benefit from the expansion of these innovations. Older adults
may have educational, visual, auditory, and cognitive impairments that
hinder their participation in remote care. The option for in-person
clinic visits should remain available for patients without access to
telemedicine services, high-risk patients or those for whom physical
examination is critical for clinical decision making.
Additionally, time should be spent for psychological support and
reassurance. Optimal self‐care includes behaviour to maintain and
increase psychological wellbeing to optimally cope with an LVAD. During
the COVID‐19 pandemic, patients have an increased level of anguish than
the general population. [35] Patients worry about being infected and
they worry about the wellbeing of their caregiver. They also worry about
changes in their relationship with their close homebound caregiver on
whom they become even more dependent. Psychological distress can be
accelerated by the lack of physical activity, social deprivation,
isolation and loneliness. The use of established behavioural and social
science approaches need to identify the active components of
“psychological support” that are most applicable to each individual
patient with a VAD.