Impact of COVID-19 on cardiovascular clinics: Are we ready for telemedicine?

Objective

The need for telemedicine was felt more than ever during the COVID-19 pandemic, which impacted health care worldwide. Therefore, this study aimed to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19, along with assessing the awareness and acceptability of telemedicine.

Methods

In this cross-sectional study, selected patients presenting to outpatient department of a tertiary care cardiac hospital were interviewed regarding the difficulties faced by patients in visiting the outpatient department during COVID-19 and their awareness and acceptability of telemedicine using a self-designed structured questionnaire.

Results

Of the 403 patients, 58.3% were male, the mean age was 53.04 ± 11.73 years, and most (77.7%) were urban residents. Ischemic heart disease was present in 69.5%, followed by hypertension (38.7%) and heart failure (29.3%). A total of 26.6% required emergency room visits. Limited appointments (55.6%) was the most common problem faced by patients during COVID-19, followed by financial issues (17.1%), fear of acquiring infection (13.4%), and limited mobility due to lockdown (22.6%). Only 12.2% were aware of telemedicine, 4.5% had previously used it, and 41.2% were willing to opt for telemedicine in the future. No internet access (39.2%) was the key barrier to the usage of telemedicine, followed by a lack of free medicine (39%) and a lack of a smart device (31.5%).

Conclusion

Limited appointments due to COVID-19 restrictions has made it difficult for patients to visit the clinics, which has led to increased emergency room visits. Telemedicine awareness was found to be limited; however, many patients were willing to adopt it provided their limitations could be overcome.

Predisposing Factors Leading to Warfarin Toxicity

Introduction: Warfarin is a commonly utilized anticoagulant in the management of thrombosis, either prevention or treatment, with bleeding problems as one of the major adverse effect because of its narrow therapeutic index. Objective: To determine the frequency of various factors leading to warfarin toxicity which was defined as patients presented with International Normalized Ratio (INR) greater than five. Setting: Department of Adult Cardiology at National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Methodology: The study type is descriptive, cross sectional. All patients who fulfilled the inclusion criteria and visited Department of Adult Cardiology at NICVD, Karachi, Pakistan were included. After ethical approval and informed and written consent. The collected data was entered using IBM SPSS - 21, for variables that were continuous mean Standard Deviation was calculated and for variables that were categorical frequency percentage were calculated. Results: Total of 87 patients with warfarin toxicity were included. 52 patients (60%) were males & 35 (40%) were females with the mean age of 48.5287 ± 13.1386 years. The factors leading to warfarin toxicity were dietary non-compliance 19 patients (21.83%), drug non-compliance in 18 (20.68%), drug-drug interactions in 12 (13.79%), irregular follow up in 23 (26.39%) and deranged liver functions in 26 (29.88%) patients. Conclusion: Warfarin toxicity has multifactorial causes. Deranged liver functions and irregular follow up of patients accounted for the most prominent factors leading to warfarin toxicity.

Successful radio-frequency catheter ablation of two cases of supraventricular tachycardia via a left-sided inferior vena cava

Congenital venous anomalies are uncommon, incidental findings encountered during adult interventional electrophysiology procedures. Femoral venous access is conventionally used during cardiac electrophysiology studies to gain access to the heart. The chance finding of an inferior vena cava anomaly may preclude the performance of these procedures from the femoral approach. We describe two cases in which we were able to successfully perform different radiofrequency catheter ablation procedures in the presence of an unusual venous anomaly, the left-sided IVC.