The pandemic has upended the care continuum in many ways, but it has also introduced new opportunities for resilience in healthcare systems, including in cardiology.
Many healthcare systems have strengthened in response to the diversity of problems facing the broader care ecosystem. These problems have run the gamut, from operational concerns (such as burnout, labor shortages, supply constraints, and financial strains) to clinical ones, such as delayed care due to backlogs.
Such barriers have required adaptation, including transformation of workflows and technology. Medical institutions have heeded the call, in part, with decentralized care models such as telehealth and at-home monitoring. Undoubtedly, these emerging systems will continue to serve cardiologists well as they tackle the remainder of the current COVID-19 crisis and whatever challenges await next.
What does this pandemic-era resilience, particularly the decentralization of care, mean for a more future-proofed healthcare system? Here are three important areas of progress to note in 2022.
1. Prompting Funding Where it Counts
International media attention on hospitals' unique pressures during COVID-19 has put the world on watch for healthcare's inherent challenges, many of which predate the pandemic. As a result of that exposure, public and private organizations have pledged funding to put the care continuum on a more sustainable path.
As one example of these funding commitments, the European Union (EU) has allocated more than €723 billion for loans and grants as part of its Recovery and Resilience Facility (RRF) package.1 While the funding is not solely earmarked for healthcare reforms, the portion of the funds that will go toward bolstering telehealth and developing new facilities will likely contribute much to the plan's broader aims.
In the United States, similar mechanisms have been approved by Congress to expand telehealth reimbursements and distribute American Rescue Plan funds to rural facilities providing Medicare, Medicaid, and CHIP services.2 These and similar investments could help catalyze necessary change in the current operations of the healthcare system, including decentralizing care for broader patient access, both geographically and via telehealth options.
2. Expanding Care Outside the Hospital
Hospitals absorb a disproportionate amount of deferred care and avoidable visits. One European study indicates that roughly 25% of visits to ED are due to inadequate care received in the primary care setting.3 During COVID-19, these trends quickly became more problematic because patients were too afraid of virus exposure to visit emergency services—amounting to a reduction in admissions for acute coronary syndrome that may be as high as 60%.4
Recognizing this, many stakeholders emphasize the importance of community-based care models that expand access to cardiac care, relieve pressure from hospitals, and detect disease states earlier. As this movement takes shape, community clinics are doing the important job of providing care outside the hospital to better balance cardiac volumes between facilities and foster resilience in healthcare systems.
However, extending cardiac care to primary care requires that the clinicians in those settings are sufficiently trained to take on that responsibility. Clinical decision support tools may help practitioners reduce their patients' reversible cardiovascular disease risk if those tools are consistently used within appropriate patient populations.5
3. Bringing Technology Closer to Patients
Cardiovascular disease (CVD) is the top cause of death in the United States. A large concern among providers is the aptitude of the healthcare system's CVD surveillance apparatus: Up to 40% of myocardial infarctions happen to people whose heart disease had previously gone undetected.6
And yet, the first time many patients encounter first-line diagnostics such as ECGs or CTs is in the emergency care setting. Could making these technologies more familiar to patients support better outcomes?
Many healthcare organizations have expanded access to mobile, outpatient, and remote monitoring capabilities in the hopes that encountering ECGs earlier in the care pathway will indeed improve outcomes. Monitoring capabilities can then digitally integrate with hospitals and diverse delivery models as needed to enable continuity of care.
With a stronger infrastructure of care that gives more people access to hospital-grade diagnostics, these models should contribute to a more resilient, efficient, and cost-effective system that improves patient outcomes without overburdening resource-strapped facilities.
To learn more about the power of the ECG in today's clinical landscape, browse our Diagnostic ECG Clinical Insights Center.
A More Resilient System Bolsters Patient Care
While healthcare administrators' response to COVID-19's impact has largely focused on not overloading hospitals, many of the healthcare system's most substantial steps regarding resilience extend outside the hospital's walls. Healthcare—and, where possible, cardiac care—is increasingly becoming more decentralized through community- and home-based care.
As more resources are devoted to these diverse models, the burden on hospital care will hopefully be reduced as a result. That balance will be critical as the care continuum simultaneously endures the remainder of the COVID-19 crisis and prepares for future challenges.
1. European Union. Recovery and Resilience Facility. European Commission. https://ec.europa.eu/info/business-economy-euro/recovery-coronavirus/recovery-and-resilience-facility_en. Accessed February 8, 2022.
2. Kaiser Family Foundation. Funding for health care providers during the pandemic: an update. https://www.kff.org/coronavirus-covid-19/issue-brief/funding-for-health-care-providers-during-the-pandemic-an-update/. Accessed February 8, 2022.
3. European Union. State of health in the EU: companion report 2017. European Commission. https://ec.europa.eu/health/system/files/2017-11/2017_companion_en_0.pdf. Accessed February 8, 2022.
4. Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. European Heart Journal - Quality of Care and Clinical Outcomes. 2020;7(1):18-27. https://academic.oup.com/ehjqcco/article/7/1/18/5956768.
5. Gold R, Larson AE, Sperl-Hillen JM, et al. Effect of clinical decision support at community health centers on the risk of cardiovascular disease. JAMA Network Open. 2022;5(2):e2146519. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788645.
6. McClellan M, Brown N, Califf RM, Warner JJ. Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2019;139(9). https://www.ahajournals.org/doi/10.1161/CIR.0000000000000652.