Impact of telemedicine network provided by local pharmacies in the management of symptomatic tachyarrhytmias during COVID-19 outbreak
Authors: Fioretti F , Piazzani M , Cani D S , Madureri A , Gabbrielli F , Gensini G F , Bollani G , Glisenti F , Nodari S 
Published: October 2021

Abstract

Background
During the lockdown in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in Lombardy. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. In other European countries interested by a national lockdown, a decrease in registered new-onset atrial fibrillation (AF) cases was observed. Undiagnosed AF patients can develop complications that could potentially translate into poorer long-term outcomes.

Purpose
In this scenario, we aimed to verify the impact of telemedicine (TLM) during lockdown, in comparison with the same period in 2019.

Materials and method
We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one TLM platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma, and Italian National Health Institute.

Results
During the lockdown period in 2020, 6,104 ECGs were performed in territorial pharmacies, compared to 17,280 ECGs recorded in the same period in 2019. Among ECGs performed, we detected AF in 344 patients (5.64%) in lockdown period, compared to 393 cases (2.27%) detected in the same period in 2019, with an increase of 40.25%. We detected also Atrial Flutter in 32 patients (0.52%) in lockdown period, compared to 25 cases (0.14%) detected in the same period in 2019. The difference was +26.92%. Moreover, we found Paroxysmal Supraventricular Tachycardia in 8 patients (0.13%) during lockdown, compared to 6 cases (0.03%) detected in the same period in 2019, with an increase of 23.07%. In lockdown period, a total of 384 patients (6.29%) were referred to ED because of symptomatic tachyarrhythmia, compared to 424 patients (3.47%) referred to ED in the same period in 2019, with an increase of 55.16%. In the Lombardy Region, during lockdown, were reported 194 cases of tachyarrhythmia in territorial pharmacies (about 50.52% of all cases in Italy). Among these, 93 cases of tachyarrhythmia were in the Brescia area (about 47.94%), whereas 50 cases were in the Bergamo one (about 25.77%).

Conclusion
These data shown that, during the COVID outbreak, a large number of patients with CV symptoms preferred to go to territorial pharmacies rather than the closer hospital. TLM played a prominent role in managing patients with CV symptoms at home. Moreover, this service allowed to refer to the hospital only patients with clinically relevant tachyarrhythmia, avoiding the risks of treatment delay. This once again underlines how TLM network provided by pharmacies may become an important tool offered to citizens, especially during coronavirus pandemic emergency, within the Italian National Health System.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Brescia Accesses in ED for tachyarrhythmiasData provided in Lombardy region