Remote Patient Monitoring in the Era of Covid-19

Hello and welcome to the October 2020 edition of Vascular Disease Management. I have chosen to comment on Dr. Edic Stephanian and colleagues’ article “Pandemic Brings New Urgency to Remote Patient Monitoring”. I have chosen this article not only as it is timely given the ongoing Covid-19 crisis, but also because it illustrates the utility of remote patient monitoring in the assessment and follow-up of patients with peripheral vascular disease.

Covid-19 has resulted in significant mortality throughout the world. Patients typically present with fever, cough, dyspnea, malaise, loss of taste or smell, muscle aches, nausea, and diarrhea. Some patients present with mild or limited symptoms while others present with overt pulmonary failure. Increased thrombogenicity has been observed in Covid-19 patients. By July 2020 more than 650,000 deaths had been attributed to this pandemic worldwide. At this time worldwide deaths attributed to coronavirus are approaching 1 million. Mortality has been much higher in the elderly and those with chronic illnesses. 

In an effort to control the spread of this pandemic, the Center for Disease Control has recommended social distancing, use of disinfectants on exposed surfaces, and the use of protective face masks. Based on these recommendations to limit disease spread, many patients have delayed subsequent follow-up evaluations of chronic disorders or post procedures and others are fearful of obtaining medical evaluation even with acute symptoms. The avoidance of appropriate health care utilization may result in adverse outcomes that could have been prevented with appropriate care. This is particularly true in patients with vascular disorders who are at risk from the underlying vascular diseases but are also at higher mortality and thrombotic risk with Covid-19 infections.

Remote patient monitoring allows healthcare providers to communicate with patients without the patient having to travel or be exposed to others. As illustrated by this article it allows continuous monitoring of patients avoiding “gaps” in care following interventional or surgical procedures. It facilitates appropriate communication between patient and health care professional. It allows providers to arrange visits in those at highest risk of Covid-19 death where there is little exposure to others and it allows the providers to screen whether or not patients may have Covid-19 infection that need to be seen in a manner that poses low risk to healthcare workers and other patients. It allows providers to assess wound healing and coupled with a blood pressure cuff and oximetry it allows hemodynamic evaluation that may signal impending failure of a surgical bypass graft or intervention. Novel new devices are being developed to help better assess vascular patients remotely.

The advantages of remote patient monitoring have become obvious during the coronavirus pandemic but I am certain that remote monitoring will continue to evolve and will be used routinely long after the pandemic is over. Remote monitoring allows for better communication, better screening, better access, and better follow-up, which result in improved, more cost-effective care. I view remote patient monitoring as the modern-day equivalent of a “house call”.  I believe that remote patient monitoring will evolve and will be routinely used in the future.