The COVID-19 pandemic disrupted the delivery of health care to patients with pulmonary hypertension (PH), primarily with respect to obtaining diagnostic testing, with aerosolized and invasive testing being the most seriously impacted, according to survey findings published in the journal Respiratory Medicine.
Patients with PH are at especially high risk from care disruptions because of their extensive health care needs and highly specialized care teams. Current guidelines for pulmonary arterial hypertension (PAH), in particular, recommend updated risk evaluation with such tools as the REVEAL 2.0 calculator at every clinical visit. Moreover, it is well known that individuals with PH have a high risk for increased mortality and morbidity from COVID-19. Investigators therefore conducted a survey of providers to assess their perceptions of how the care of patients with PH was affected during the COVID-19 pandemic.
The survey, which comprised 47 questions associated with the care of patients with PH, was developed by the American College of Chest Physicians 2020-2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee. The survey was sent to all members of the PVD NetWork and to providers connected with many other professional networks for PH. All responses to the survey, which were collected between November 2020 and February 2021, were anonymous. A total of 95 providers responded to the survey.
Results of the study showed that 93% of respondents believed that care of patients with PH had been affected by the pandemic, with 67% observing decreased referrals for PH assessment during this period.
A dramatic shift to using telemedicine also occurred with this patient population. Before the COVID-19 pandemic, only 15% of providers had utilized telemedicine for the management of their patients with PH, compared with 84% during the pandemic. Telemedicine was used most often for follow-up of selected low-risk patients (49% overall). Willingness to prescribe new treatment for PAH via telemedicine varied among survey respondents, with 22% indicating they were completely willing to prescribe new treatment via telemedicine and 11% indicating they were completely unwilling. Notably, providers’ comfort level varied according to the type of medication being prescribed.
With respect to other care disruptions, more than 90% of providers surveyed reported disruptions in obtaining testing, and 31% reported disruptions in renewal or approval of medications.
Survey limitations include: selection bias, a preponderance of respondents from the US, and unanswered questions by some respondents.
The authors concluded that “Adapting to the challenges that COVID-19 has presented will ultimately simplify the care of patients with PH by necessity, thereby increasing accessibility and hopefully improving patient outcomes.”
Zhou CY, Sahay S, Shlobin O, et al. Effects of COVID-19 pandemic on the management of pulmonary hypertension. Respir Med. Published online November 26, 2022.