After two years of disruption, many countries are lifting COVID-19 restrictions to try to establish a ‘new normal’. Heart failure care has been severely disrupted over the past two years, which presented major challenges for people living with the syndrome. People with heart failure are at higher risk of complications from COVID-19 and many continue to exercise a great deal of caution.
Despite these challenges, the pandemic has also led to a great deal of ingenuity in care delivery, support and self-management. At the Heart Failure Policy Network, we have been talking with our community about the key lessons learnt from the pandemic and how they can help shape the future of heart failure care.
The delivery of care via telephone and video calls has dramatically increased during the pandemic. In France, for example, the number of reimbursed teleconsultations grew from 40,000 in February 2020 to 5.5 million between March and April that year, and they continue to be offered as an alternative to face-to-face appointments. While remote consultations will not be appropriate for everyone with heart failure, some people find them much more convenient than in-person. Not having to travel to a hospital or clinic can save time and money, especially for people who do not have easy access to transport services.
Monitoring and managing symptoms at home has been found to improve quality of life for people with heart failure. During the pandemic, self-management has enabled people to keep track of their symptoms thanks to the rapid development and uptake of digital health technologies, from real-time data feeds from implanted devices to smartwatches that track heart rate and exercise. For some people, these developments are liberating and empowering, providing them with insight and control over their care. But some find them dehumanising. This ‘digital divide’ in healthcare will deepen if people do not receive adequate support to use telemonitoring tools that are suited to their individual needs. What this also tells us is that digital tools for self-management should never completely replace face-to-face care and at-home or clinic-based disease management programmes led by multidisciplinary teams.
Public appreciation for healthcare professionals – especially nurses – increased during the pandemic. This must now be backed up with psycho-social support to deal with the trauma of the pandemic, as well as accreditation, recognition and further investment in the field of nursing. Heart failure specialist nurses are central to multidisciplinary care models, which can deliver better outcomes for people living with the syndrome. Yet in many European countries they are not accredited, resulting in the expertise of this role being unrecognised and making it vulnerable to redeployment or cuts. We should ensure that nurses and other healthcare professionals involved in heart failure care are adequately supported in the years ahead.
Some of our members have emphasised the incredible work done by charities and patient organisations at the start of the pandemic. When information on COVID-19 was scarce and healthcare professionals were working on the front line, groups such as Pumping Marvellous in the UK collated and disseminated resources for people living with heart failure and their loved ones. They also provided much needed support, information and even entertainment to people with the syndrome, many of whom were advised not to leave their homes. The power of collaboration and desire to improve has been prevalent throughout the pandemic and should continue to drive conversations about the future of heart failure care. Patient advocates should continue to be central to these conversations.
The emergence of post-COVID-19 syndromes, collectively known as long COVID, and increasing recognition of their impact on the population, has led to a renewed focus on chronic conditions in the media and in public discourse. Many people with enduring symptoms are unable to access appropriate care, but a number of multidisciplinary long-COVID clinics have been established across Europe. These could serve as an inspiration for establishing multidisciplinary, integrated care hubs for people living with heart failure. Crucially, the political and public will behind these clinics has been very strong, with many people and institutions appearing to appreciate the personal, social and economic impact of chronic conditions for the first time.
People living with heart failure could benefit from the transformations that are starting to occur in the wake of the pandemic, including the development of innovative tools for self-management and early diagnosis. The heart failure community should seize the opportunity to engage with the public conversation about the impact of chronic illness, the challenges of workforce shortages and future sustainability of healthcare in the context of post-COVID-19 recovery. They can use the lessons learned during this period of immense change and push for a new world in which all people with heart failure receive the best possible care.
Blog post by Catherine Hodge, Researcher, Heart Failure Policy Network