2a) Our guest faculty today are expert 🇺🇸 #cardiologists & trialists @MarcBonaca of https://t.co/mW7pJ8gnRk & @MkosiborodMD of St Luke’s Mid-America Heart Institute, both of whom are established @cardiomet_CE faculty and we are so pleased to welcome them back! pic.twitter.com/mJGaLkX8xY
— cardio-met (@cardiomet_CE) August 24, 2022
3) Their work, entitled “International Perspectives on the Impact of the #COVID-19 Pandemic on #Adherence to #DAPT: A Window into #Acute #Cardiovascular Care,” was supported by an educational grant from AstraZeneca. Disclosures & accreditation statement at https://t.co/gvXca4G9Xm
— cardio-met (@cardiomet_CE) August 24, 2022
5) Increasingly, researchers are starting to take stock of the impact of #COVID19 on #cardiovascular disease and #outcomes. See 🔓https://t.co/qgaSd7p4uH and 🔓https://t.co/G6kDbalgBW. pic.twitter.com/S1SouxzlMx
— cardio-met (@cardiomet_CE) August 24, 2022
7) Pts with known #CAD are often prescribed #P2Y12i, esp after a #PCI. Consistent #adherence relies on #patient_education & #collaboration with the #healthcare team. As the pandemic disrupted this relationship, the likelihood of nonadherence might be assumed to ⬆️. pic.twitter.com/MD5IahFUIz
— cardio-met (@cardiomet_CE) August 24, 2022
9) @MarcBonaca & @MkosiborodMD both described the #pandemic‘s impact on #cardiovascular care & research &, as much as poss, on #DAPT adherence & the implications thereof. They both practice in diverse settings & address the differences in urban vs rural #cardiology care as well.
— cardio-met (@cardiomet_CE) August 24, 2022
10b) … preventative care, elective screening, & #imaging studies/#interventional procedures for evals of symptomatic patients
— cardio-met (@cardiomet_CE) August 24, 2022
👉dramatic & sustained shift in public attention away from chronic disease conditions (#CAD #PAD #HF #diabetes, #KidneyDisease, #cancer to COVID-19 care
12) Care in #rural areas of the US was particularly hampered by the lack of adequate access to virtual care, which required both availability of #broadband internet & a certain degree of technology savviness from the patients, who in rural areas tend to be older. pic.twitter.com/PafNtURoc7
— cardio-met (@cardiomet_CE) August 24, 2022
13b) . . . which in part further contributed to care avoidance and suboptimal management of chronic diseases in these patient groups. pic.twitter.com/JwDJaSaVyh
— cardio-met (@cardiomet_CE) August 24, 2022
15a) Because of pre-existing barriers to access, rural communities were even more susceptible to this, ultimately resulting in discounting the importance of adherence to lifesaving medications and lifestyle interventions.
— cardio-met (@cardiomet_CE) August 24, 2022
15c) Unfortunately, many patients (esp in rural areas) essentially gave up on self-management techniques early in the pandemic, & in many cases, this went undiscovered by the #healthcare team until many months later—when the patients finally had an opportunity to be evaluated.
— cardio-met (@cardiomet_CE) August 24, 2022
17) Groups among whom urgent or emergency care avoidance exceeded 20% and among whom any care avoidance exceeded 50% included adults 18-24, unpaid caregivers for adults, #Hispanic adults, persons with disabilities, & persons w/2+ underlying medical conditions, including #CAD. pic.twitter.com/xlV0Lcf0Q8
— cardio-met (@cardiomet_CE) August 24, 2022
19a) Greater availability of virtual care is here to stay & will change care delivery in the long term. As the pandemic eventually recedes, many in-person interactions will return, but the capabilities to effectively deliver care (esp preventive care & chronic disease mgt) …
— cardio-met (@cardiomet_CE) August 24, 2022
20) Which of the following characteristics of rural vs urban US populations is NOT true?
— cardio-met (@cardiomet_CE) August 24, 2022
a. older mean age
b. higher comorbidity burden
c. more access to virtual care
d. less access to specialty care
22) Welcome back to our CE/#CME-accredited discussion of Impact of the #COVID-19 Pandemic on Adherence to Prescribed #DAPT: A Window into Acute Cardiovascular Care.#FOAMed @MedTweetorials #Cardiotwitter
— cardio-met (@cardiomet_CE) August 25, 2022
We continue today to hear from expert faculty @MarcBonaca & @MkosiborodMD
24b) Yesterday’s quiz (see tweet 20)? The correct answer is c. Rural US populations have LESS access to virtual care—not because they couldn’t use it, but because of infrastructure limitations on reliable access to the internet.
— cardio-met (@cardiomet_CE) August 25, 2022
25) Patients were delaying or not showing up for visits and delaying care for cardiovascular procedures that were medically needed. As a result, people were presenting acutely with more advanced and harder-to-treat disease.
— cardio-met (@cardiomet_CE) August 25, 2022
26b) … to telehealth or other “novel” means of engagement has been variable. There are patients who very much value face-to-face interaction and some will drive for several hours to come in for a preventive visit even when offered telehealth.
— cardio-met (@cardiomet_CE) August 25, 2022
26d) … when pts were asked how much of their medical care they wanted to receive through video visits after the COVID-19 pandemic, 33.5% preferred all of their care to be in person & 66.5% wanted at least some video visits. 10.3% wanted as much as possible.
— cardio-met (@cardiomet_CE) August 25, 2022
27a) Ordering of diagnostic testing and medications consistently decreased when comparing pre-COVID-19 versus COVID-19 and in-person versus remote visits, and it was unclear whether these decreases represent⬇️in or underuse of indicated testing/tx (🔓https://t.co/5u7DTOtFwb) pic.twitter.com/3RNVAhhXt9
— cardio-met (@cardiomet_CE) August 25, 2022
27c) … in other ways (job loss, caring for a family member, etc) where adherence with therapy becomes a lower priority. These were not new issues, but #COVID-19 worsened the situation . . .
— cardio-met (@cardiomet_CE) August 25, 2022
28a) Nationally in 🇺🇸, we saw objective pandemic-related indicators of change in the volume of acute cardiac care. Example:🔓https://t.co/1yFYW85UQ4: #STEMI activations for 9 high-volume centers 1/1/19-3/31/20 ➡️a ⬇️in STEMI activations of 38% once the pandemic began.
— cardio-met (@cardiomet_CE) August 25, 2022
29) Measures our institution is considering implementing in anticipation of the “next” public health crisis that might disconnect patients on #DAPT from their care team are not novel but are instead more likely to reflect continuation of measures that we are putting in place now.
— cardio-met (@cardiomet_CE) August 25, 2022
30b) There are some systems (eg, direct drug shipments to patients, better tracking programs, reminders, care team approach to adherence) that need to be further developed, including delivery of more personalized remote care.
— cardio-met (@cardiomet_CE) August 25, 2022
30d) . . . how these terrible diseases impact individuals, often disproportionately. If a patient cannot feed herself or her family, then #adherence to #DAPT is likely not her priority.
— cardio-met (@cardiomet_CE) August 25, 2022
32) It’s c: the average in-office visit takes 121 minutes, including 101 minutes of commute and waiting room time—only 20 minutes with the doctor.
— cardio-met (@cardiomet_CE) August 25, 2022
33) So now, #physicians #PAs #nurses #NPs #pharmacists can go to https://t.co/HJm9UDFhyw and collect 0.5h CE/#CME. And follow us here for the BEST & MOST INNOVATIVE @cardiometabolic education–right here on Twitter! Thanks to @MarcBonaca & @MkosiborodMD #FOAMed #Cardiotwitter
— cardio-met (@cardiomet_CE) August 25, 2022