Rapid Virtualization of a Heart Function Clinic in Response to the COVID-19 Pandemic

PURPOSE: The current COVID-19 pandemic has had an unprecedented impact on healthcare systems across the world. It has stretched to the limit acute care systems, indirectly it has shaped new and innovative ways to deliver care for those with chronic conditions. Herein we describe initial outcomes of the rapid virtualization of the Heart Function Clinic at a major quaternary Hospital in Toronto, Ontario. METHODS: Consecutive patients attending the heart function clinic at the Toronto General Hospital between March 9, 2020 and June 30, 2020 were included. Visits were classified as “in-person” if patients were physically present for the clinical interaction and “virtual” if the clinical interaction occurred while the patient was away using currently available modes of communication: telephone or web-enabled (Ontario Telemedicine Network -OTN, or other available web-based applications). The purpose of the individual visit was categorized as: “surveillance”, “titration”, “new assessment” or “Clinical trial”. RESULTS: A total of 292 patients had a total of 521 clinical encounters during the lockdown period. Of these, 168 (32.2%) were “in-person”, while 353 (67.8%) were “virtual”. 101 (19.3%) were primarily for the purposes of titration. These virtual assessments led to 14(2.7%) in-person assessments. 258 (49.5%) of patients had an LVEF < 40%, among these patients 220 (85.3%) were on an ACEi, ARB or ARNi, 242 (93.8%) on a Betablocker, 191 (74%) on an MRA, 46 (17.8%) on SGLT2inhibitor. CONCLUSION: Rapid virtualization of a large academic multi-disciplinary clinic is possible. This allows for ongoing delivery of safe care to patients with chronic conditions and can be used as a model for other clinics facing the pandemic. Lessons learned will be used to transition to a hybrid model of in-person and virtual even after the pandemic has come to an end.