Better understanding of the challenges, needs and actions required to effectively manage cardiovascular patients remotely was the focus of an ACC Heart House Roundtable last month exploring telehealth and the intersection of technology and health care. The roundtable was part of the ACC's ongoing education efforts tied to the COVID-19 pandemic.

"With the outbreak of COVID-19, many outpatient clinics and facilities find themselves not prepared for regular telehealth visits," said ACC President Athena Poppas, MD, FACC, who kicked off the meeting. "This Roundtable is essential in bringing stakeholders together to move us forward in identifying critical gaps and needs."

Roundtable Co-Chairs Ami B. Bhatt, MD, FACC, and Jason H. Wasfy, MD, MPhil, FACC, highlighted the importance of convening stakeholders from payers, to industry, to clinicians to identify lessons learned and move towards a high-value telehealth strategy for the cardiovascular community that can extend beyond COVID-19.

"We are here because it matters, and we truly have an opportunity to develop unique and collaborative solutions for our joint challenges," said Wasfy.

Like other Heart House Roundtables, participants were able to hear from expert faculty on topics ranging from use of telehealth as secondary prevention for the high-risk ASCVD patient to recent changes to telehealth regulations and reimbursements. They then took part in focused, small group discussions addressing ways clinicians can empower patients; opportunities for cost savings; use of telehealth in high-risk patients; and more.

Patient needs were a common thread throughout the Roundtable with several speakers noting telemedicine as a way to increase the social and emotional connection in the absence of in-person visit.

However, technological challenges and difficulty with assessing vital signs were among the limitations cited by faculty and participants alike.

Some solutions: leveraging support staff within a practice, as well as care providers or family members, to prepare patients for a virtual visit; allowing for flexibility with technology solutions; and finding balance with the needs of patients and the physician-led care team.

"Nothing can absolutely replace the gold standard of in-person care," said Roundtable faculty Cathleen Biga, MSN, FACC, "but telehealth has proven to be a lifeline." Looking ahead she said telehealth has the potential to replace 20% of all office/outpatient services, resulting in a potential 7% reduction in health care spending.

Coming out of the Roundtable one of the key takeaways was the need for a pilot project or trial assessing value and comparative effectiveness of telehealth, with patient and provider satisfaction and adherence to treatment among the endpoints. Equity was also identified as a critical endpoint to better understand the benefits and limitations of telemedicine across patient populations.

"We need ACC to help eliminate disparities that might be emphasized by this transition," said Harlan Krumholz, MD, SM, FACC. He highlighted the importance of partnering with patient advocacy groups and societies like the Association of Black Cardiologists.

Others also stressed the importance of legislative efforts, working with public/private payers on the continued movement away from fee-for-service to value, and leveraging registries when possible.

What's next? According to Bhatt, the ACC plans to summarize all the key takeaways with the goal of translating them into actionable outputs hopefully to further necessitate the role of telehealth in cardiology practice.

"Whether this includes enhancing existing clinical policy and tools to accommodate telehealth protocols, developing new guidance and resources to improve care delivery, or both is still to be determined," she said.

"However, the ACC, and its members, are committed to helping clinicians navigate the complexities of telehealth in order to provide optimal cardiovascular care and outcomes for the patients we serve."

The ACC's ongoing COVID-19 education initiative, including the series of Heart House Roundtables, is supported in part by Boehringer Ingelheim Pharmaceuticals Inc. & Eli Lilly and Company, and Bristol Myers Squibb, and Novartis Pharmaceuticals Corporation.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD)

Keywords: ACC Publications, Cardiology Magazine, COVID-19, severe acute respiratory syndrome coronavirus 2, Fee-for-Service Plans, Pilot Projects, Cost Savings, Secondary Prevention, Pharmaceutical Preparations, Health Expenditures, Personal Satisfaction, Delivery of Health Care, Patient Advocacy, Pandemics, Goals, Telemedicine, Risk Factors, Uncertainty, Peripheral Arterial Disease, Negotiating, Cardiovascular Diseases, Healthcare Disparities, Consensus, Trustees, Benchmarking, Leadership, Public Health

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