B-po03-062 effect of the covid-19 pandemic on outpatient care of patients with crt devices

The COVID-19 pandemic has posed unique challenges to outpatient care delivery, particularly for patients with CRT devices. Among patients with CRT devices, we aimed to identify patient and device-related characteristics that may predict outpatient utilization during the COVID-19 pandemic compared to an analogous pre-COVID period. We sought to identify subsets of patients that may be particularly susceptible to suboptimal care. We performed a retrospective analysis of demographics, comorbidities, device-detected parameters and their association with cardiac outpatient utilization among Medtronic CRT patients within the Mass General Brigham System. Data was extracted from the Medtronic Carelink database between March 1st through June 30th of both 2019 and 2020. Paired t-test or chi-squared tests were performed as appropriate, and a p-value <0.05 was considered statistically significant. Among 394 patients, in-person outpatient visits decreased 4.5-fold, from 576 in 2019 to 126 in 2020, while virtual visits increased ∼17-fold from 21 to 350 (p<0.0001). In univariate analysis with 15 variables of interest, parameters significantly associated with outpatient encounters in 2020 included male gender, white race, presence of ischemic cardiomyopathy (iCM), advanced (NYHA class III or IV) heart failure, use of anti-arrhythmic drugs, and higher levels of device-detected non-sustained tachycardia. Notably, an under-represented minority status was significantly associated with a reduction in outpatient encounters. Among all outpatient encounters, there was no association between demographics (age, gender, race) and use of in-person versus virtual outpatient care. Among CRT patients in a large urban healthcare system, there was a significant shift towards virtual outpatient care in 2020. A significant reduction in outpatient encounters were noted in under-represented minorities. No single demographic characteristic was associated with the mechanism of outpatient care, i.e. in-person versus virtual.