793 A single-centre experience with telemedicine-integrated chronic coronary syndrome care
Authors: Restivo Attilio , Ciliberti Giuseppe , Laborante Renzo , Libbi Lucrezia , Casamassima Fabio , Ierardi Carolina , Leone Antonio Maria , D’Amario Domenico 
Published: December 2021

Abstract

Aims
Over the last decades, both the improvement in cardiovascular prevention programmes and the advancement in medical and invasive therapies facing ischaemic heart disease have granted an outstanding reduction in mortality rates. However, coronary heart disease remains, by far, the most common disease in developed countries, and the progressive ageing of population leads to a constantly increasing prevalence of chronic coronary syndrome (CCS). The consequence is an unsustainable demand for access to collapsing hospital clinic and doctor’s office. The dramatic Covid-19 era has become the testing ground for alternative ways to deliver healthcare avoiding in-hospital contacts, thus affirming the validity of telemedicine as a key tool to improve the patient journey. In our centre, video consults have been integrated to CCS patients’ clinical care pathway, not only preventing the risk of contagion but also laying the groundwork for a paradigm shift in clinical care course.

Methods and results
Since pandemic outbreak, Lazio Region offered to its inhabitants free of charge teleconsulting for both primary care and specialist referral. At the cardiovascular department of Fondazione Policlinico Gemelli IRCCS, this opportunity has been recently applied to optimize the chronic coronary syndrome patient journey. Specifically, videoconsulting has been used in different steps of CCS clinical course, replacing both in-person first visit and follow-up consultation after percutaneous myocardial revascularization. Being CCS a context in which the therapy optimization or the transition to higher level tests are mainly indicated by symptoms, these remote consultations could work as well as in-hospital visits to assess risk stratification and to consequently arrange the best therapeutic–diagnostic pathway. Besides, as COVID-19 pandemic caused significant delays, further remote visits have addressed the need to keep in contact with patients waiting for coronary angiography and to reassess their urgency criteria. In our department, over last 9 months, 141 patients have been examined and followed-up through teleconsulting, amounting to 34.1% of all supplied visits. Despite a high median age (67 ± 19.7 years), the drop-out rate of the contacted patients due to inability or denial was quite low (7.5%) and this high adherence to videoconsulting suggests time is ripe for a full telemedicine employment in clinical care course. In the cohort of patients waiting for coronary angiography, a telemedical reassessment led to a significant rate of priority class switch (42.7%), probably preventing adverse cardiac events in those individuals with worsening symptoms (systematically evaluated using Seattle Angina Questionnaire). Of note, the implementation of this parallel virtual pathway for these patients allowed us to decrease the waiting times for in-person visits at our CCS clinic, with an estimated time reduction of almost 3 months. This result supports our idea that the adoption of a remote pathway for chronic illness management, like CCS, may provide more opportunities for treatment of severe cases at in-person clinics that are often overcrowded.

Conclusions
In conclusion, all the potential of telehealth to empower primary and specialty health care is gradually emerging, and CCS seems the perfect setting for an integrated physical and virtual health system.