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.