key: cord-0984814-ppefl1pe
authors: Oliveros, Estefania; Mahmood, Kiran; Mitter, Sumeet; Pinney, Sean P.; Lala, Anuradha
title: Letter to the Editor: Pulmonary Artery Pressure Monitoring during the COVID-19 Pandemic in New York City
date: 2020-08-14
journal: Journal of Cardiac Failure
DOI: 10.1016/j.cardfail.2020.08.003
sha: afda08f40d2f2ded185b27e77ec6137091f359eb
doc_id: 984814
cord_uid: ppefl1pe

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We similarly aimed to ascertain whether stay-at-home mandates would result in changes in pulmonary artery diastolic pressures among patients with HF and W-IHM. In our larger cohort, we made the following observations: 1) the rate of W-IHM transmissions by patients increased as did the number of interventions by clinicians (phone calls, text messages and video encounters) during the pandemic; 2) there was no significant difference in the mean PADP prior to and during COVID-19 (19.4 ± 5.6 mmHg and 18.9 ± 6.7 mmHg (p = 0.654) respectively), nor was there a difference in the mean HR (79.9 ± 14.4 vs. 78.9 ± 15.3 bpm (p = 0.8105) respectively) ( Figure 1) ; 3) the number of HF hospitalizations was lower during the pandemic.

Patients transmitted readings an average of 17.8 ± 9.1 times per month in the period pre-COVID 19 compared to 18.9 ± 9.9 times per month during COVID-19 (p=0.526). During the latter period, individuals had a range of 0 to 4 interventions in a month, and of those, 13 (32.5%) had an increase in diuretics, 8 (20%) had a decrease in diuretics, and 1 (2.5%) had a change in guideline directed medical therapy. Similarly, during COVID-19, individuals had a range of 0 to 5 interventions in a month, and of those, 16 (40%) had an increase in diuretics, 7 (17.5%) had a decrease in diuretics, and 1 (2.5%) had a change in guideline directed medical therapy.

Our study has similar limitations to those reported by Almufleh et al, in that generalizability is limited due to the small cohort size and retrospective study design.

Behavioral changes as a result of home isolation during the COVID-19 pandemic may be bidirectional. Increased anxiety may drive poor dietary choices. Conversely, a reduction in daily activity may decrease autonomic tone and result in increased medication compliance, daily weight monitoring and transmission of PAP via W-IHM. As COVID-19 continues to spread and result in morbidity and mortality, reliance on remote monitoring is likely to increase. We agree with Almufleh et al that vigilant monitoring, and in particular management of remote monitoring 4 devices, may at least in part explain the decrease in HF hospitalizations despite patient reluctance to seek medical care; however, we failed to find the initial PAP volatility reported in Boston.

More reports are needed to determine the effects of social changes inflicted by COVID-19 restrictions on congestion, compliance and outcomes among patients with HF and W-IHM. 

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