Editorial: Telemedicine in the Era of Coronavirus 19: Implications for
Post-Operative Care in Cardiac Surgery
Omar M Lattouf MD PHD FACC FACS
Professor of Surgery, Emeritus
Emory University School of Medicine
Dr. Aminah Sallam and colleagues are to be commended on their article
titled “Telemedicine in the Era of Coronavirus 19: Implications for
Post-Operative Care in Cardiac Surgery” published in the Journal of
Cardiac Surgery.
In this article, the authors reported results of small study on fifty
patients who had undergone cardiac operations during the height of the
coronavirus pandemic, and underwent follow-up with their surgeons via
telephone or via video-supported methods.
Interestingly, the level of satisfaction by both patients and surgeons
for utilizing telemedicine was high with, reportedly, all surgeons
prefer to see patients post-operatively using telemedicine and 46% of
patients would still take telemedicine post operative visits over
in-person visits even if there was no “stay-at-home orders”.
These noteworthy findings deserve the attention of every practicing
cardiac surgeon in this ever-changing environment, where external
pressures on the cardiac surgical practice are mounting. One such
example of important and relevant external pressures is the impending
threat for upward of 20% of Medicare reimbursement cuts for
cardiothoracic surgery remains real and would have catastrophic impact
on the practice of cardiothoracic surgery. Thus it behooves us to deploy
every possible method to enhance our services to our patients, protect
the cardiac surgical specialty and our ability to provide life-saving
care to our patients.1
In this era were simulation-based training has become common in cardiac
surgery2 and virtual reality has become an important
aspect of our everyday life3, perhaps it is time for
us, cardiac surgeons to “jump on the band wagon” and not let this
opportunity to expand our connectivity, and bonding, with our patients
and their families slip by us.
Cardiac surgeons, as healthcare leaders who have advanced the care of
the cardiac patients and have been critical in introducing cutting edge
technologies into the cardiac care in particular4 and
into the entire field of medicine in general, should continuously
examine ways to improve patient care irrespective of patients’
geographic locations. And as we have always done, we should aspire to
improve the quality of patient care in every way
possible5, inside the walls of our hospitals and
clinics as well as when patients are in their own home environment.
The use of telemedicine is one such way through which we can provide
virtual care, health education and expanded connectivity.
One of the many important lessons we have learned since the Covid
pandemic is that we have to be innovative and creative in order to
provide critical patient care and help patients stay
healthy6.
Telemedicine has been shown over the last several decades to bring much
needed health services to patients in remote areas7.
NASA’s unique contribution to telemedicine by creating technologies to
provide medical care to astronauts during space missions have benefitted
not only the astronauts, or the American citizens but has also served
people from all over the world8.
Cardiac diseases afflicts millions of people around the globe, is one of
the leading causes of death and is associated with multiple comorbid
factors such as stroke, depression, obesity, hypertension, diabetes and
smoking9.
Rural America has its not-small share of patients who are suffering from
CV diseases, many at remote areas with lesser access to cardiovascular
specialists than urban populations10.
Patients who are in need of pre-operative cardiac care as well as
patients who are in need of post-operative follow-up would benefit from
telemedicine-supported visits. Such patients could remain in frequent
contact via telemedicine with their providers until their conditions
stabilize, wounds heal and are back into being independent and capable
of self-care.
In conclusion, tele-medicine in cardiac surgery has the potential of
many benefits such as:
- Allow early introductions of patients to surgeon while patient is
still at home or at a remote clinical facility.
- Video-personalized meeting in advance of patient scheduled admission
to hospital for planned surgery with patient and their families or
care-providers without burdening the entire family to travel and incur
the cost and lengthy times of travel and waiting. Family members from
different locations could attend such video-supported session, thus
enabling multiple parties to join, meet the surgical team and learn
about the details of the operative procedure, associated benefits and
risks and have opportunity to ask questions. .
- More frequent video-supported visits of patient post discharge while
at home.
The time is now for cardiac surgeons to embrace tele-medicine and
incorporate it into our every-day practice.
References
- Alan M. Speir, Courtney Yohe, Stephen J. Lahey, Julie R. Painter, and
Francis C. Nichols, on behalf of the STS Workforce on Health Policy,
Advocacy, and Reform, and the Workforce on Coding and Reimbursement.
2020 Medicare Final Payment Rule: Implications for Cardiothoracic
Surgery. Ann Thorac Surg 2020; 109:313-6.
- Igo B. Ribeiro, Janet M. C. Ngu, Buu-Khanh Lam, and Roger A. Edwards.
Simulation-Based Skill Training for Trainees in Cardiac Surgery: A
Systematic Review. Ann Thorac Surg 2018; 105:972–82.
- KIMBERLY J. MILLER, BROOKE S. ADAIR, ALAN J. PEARCE, CATHERINE M.
SAID, ELIZABETH OZANNE, MEG M. MORRIS. Effectiveness and feasibility
of virtual reality and gaming system use at home by older adults for
enabling physical activity to improve health related domains: a
systematic review. Age and Ageing 2014; 43: 188–195
- Richard J. Shemin. The Future of Cardiovascular Surgery.Circulation . 2016; 133:2712-2715
- Lawrence H. Cohn. WHAT THE CARDIOTHORACIC SURGEON OF THE TWENTY-FIRST
CENTURY OUGHT TO BE. J Thorac Cardiovasc Surg 1999; 118:581-7.
- Judd E. Hollander, and Brendan G. Carr. Virtually Perfect?
Telemedicine for Covid-19. NEJM 382;18 April 30, 2020; 1679-1681.
- Michael E. DeBakey. Telemedicine Has Now Come of Age. Telemedicine
Journal. Jan 1995.3-4. Volume: 1 Issue 1: January 29, 2009.
- Doarn CR, Nicogossian AE, Merrell RC. Application of telemedicine in
the United States Space Program. Telemed J. 1998; 4(1):19–30.
- Heval M Kelli, Ibrahim Kassas and Omar M Lattouf. Cardio Metabolic
Syndrome: A Global Epidemic. J Diabetes Metab 2015, 6:3
- Julie A. Nelson, and Barbara Stover Gingerich. Rural Health: Access to
Care and Services. Home Health Care Management & Practice 22(5)
339–343