Integrated Distance Management Strategy for Patients With Cardiovascular Diseases in the Context of COVID-19
Integrated Distance Management Strategy for Patients With Cardiovascular Diseases in the Context of COVID-19
Management of known patients with cardiovascular disease (in particular the whole spectrum of
 atherosclerotic ischaemic coronary artery disease, essential hypertension under treatment,
 and also patients with chronic heart failure under medication) and with other associated
 chronic pathologies, with obvious effects on the management of the pandemic with modern /
 distance means (e-Health) of patients at high risk of mortality in contact with coronavirus.

 Given the Covid-19 Pandemic, all the above complex cardiovascular patients are under the
 obligation to stay in the house isolated and can no longer come to standard clinical and
 paraclinical monitoring and control visits. Therefore, a remote management solution
 (tele-medicine) of these patients must be found.

 The Investigators endeavour is to create an electronic platform to communicate with these
 patients and offer solutions for their cardiovascular health issues (including psychological
 and religious problems due to isolation).

 The Investigators intend to create this platform for communicating with a patient and
 stratify their complaints in risk levels. A given specialist will sort and classify their
 needs on a scale, based on specific algorithms (derived from the clinical European
 Cardiovascular Guidelines), and generate specific protocols varying from 911 like emergencies
 to cardiological advices or psychological sessions. These could include medication changing
 of doses, dietary advices or exercise restrictions. Moreover, in those patients suspected of
 COVID infection, special assistance should be provided per protocol.
Specific objective 1: Establishing the risk profile of the patient with cardiovascular
 disease

 Specific objective 2: Development of an electronic (e-HEALTH) framework structure for
 management of patients with known cardiovascular disease in COVID19 pandemic social context

 (Cardiology specialists, interventional cardiology, cardiovascular surgery, oncology,
 infectious diseases, diabetologists, family doctors, psychologists / psychiatrists, priests
 and religious advisors).

 -  the patient is included in the AngioNET research database and automatically creates an
 account on the M platform and gives the consent for the data transfer on the platform or
 the patient registers directly on the M platform and uploads his medical data (analysis
 and imaging) to his personal account;

 -  patients complete the section with data specific to the coronavirus pandemic;

 -  the patients select the type of consultation they request and they are redirected to
 specific sections with dedicated multidisciplinary teams;

 -  patients come into direct contact with the case coordinator, who provides ongoing
 assistance, including for connecting to devices that ensure real-time data transmission
 and directing to specialist teams that establish stage diagnosis and management /
 therapy behavior (including adjustment). doses, decisions to discontinue medication or
 to add medication);

 -  the classification of patients in emergency categories and the follow-up of specific
 trajectories:

 -  1 - 911 for transporting patients to the hospital in an emergency (for cardiovascular
 emergencies or COVID symptoms);

 -  2 - adjusted drug therapy, followed by accelerated monitoring for periodic evaluations
 in order to decide to pass in category 1 or 3;

 -  3 - establishing drug treatment and monitoring. Over all these categories, specific
 protection measures in the case of coronavirus infection overlap

 -  monitoring the short and medium term evolution of patients in isolation (vital
 parameters, transmitted through the provided wireless devices)

 -  Detailed / and largely based protocols will be developed based on the recommendations of
 the Guidelines, but also on the experts' opinion and on the local expertise (pandemic,
 national emergency) for at least three categories.

 Deliverables for specific objectives:

 -  functional management platform for patients with cardiovascular disease, bodily and
 intangible assets necessary for the functioning of the platform;

 -  multidisciplinary teams with the reaction speed adapted to the specific of each case /
 emergency category;

 -  emergency counseling schemes, including psychological and religious counseling;

 -  collection, interpretation and processing conclusions given in management optimization
 policies for patients with cardiovascular diseases.

 Specific objective 3: Procedures regarding interventions on categories classified by
 cardiovascular emergencies

 Activities for achieving the objective:

 -  elaboration of procedures on categories of emergencies in the presence of coronavirus:
 1- urgent interventional / surgical / hybrid therapy; 2- short-term drug treatment for
 the subsequent therapeutic intervention; 3 - drug treatment for cardiovascular pathology
 doubled by coronavirus treatment

 -  follow-up for obtaining medical data, including epidemiological and related to the
 environmental parameters at the place where the patient belongs and their processing for
 the purpose of optimizing public health measures in patients with cardiovascular
 diseases

 Specific objective 4: Campaign to promote the distance management method through specific
 e-Health methods to mitigate the psychological impact of using the distance diagnosis and
 treatment and implementing the procedures

 The social pressure brought about by isolation of patients who would otherwise have benefited
 from frequent outpatient consultations for various problems, such as: adjusting doses of
 antihypertensive treatment, managing sporadic chest pain, managing body weight and diuresis
 in patients with heart failure, adjusting the schema, treatment based on heart rate and
 diuretic doses, chronic oral anticoagulant treatment or management of supraventricular
 tachyarrhythmias or extrasystolys at home.

 In addition, isolation at home puts another kind of pressure (psychic in essence) on the
 patients who are also suffering from the mentioned chronic pathology. These patients bring
 the stress of isolation in relation to their own person, family / contacts, but also with the
 medical team in possible digital / wireless contact.

 At this time, there are no management protocols for patients with such a degree of
 complexity, the telemetry problem being only isolated, as far as local resources and specific
 objectives are concerned, in no case viewed in their entirety.

 The major problem that arises with the isolation of these patients is that they cannot be
 admitted to hospitals for problems of low severity compared to the current territorial
 capacities, and at the same time, they cannot be left unattended - by abolishing / blocking
 the medical activity in the specialized outpatient clinics. .

 It cannot be said that there is similar experience with the current epidemiological situation
 and there are no Guides or directions of institutionalized medical practice.

 This particular situation more likely makes experts to witness an increase in the
 complications of cardiovascular diseases through the lack of direct management (heart failure
 compensations), early and long-term complications of tension jumps or uncontrolled tension
 values, and possibly acute coronary syndromes).

 Moreover, the coronary patients who are instrumented by stenting, see the impossibility to
 come to the periodic checks at 1 month, 3 months, 6 months, 9 months and one year after the
 coronary stenting, as there is no alternative solution to the closure of the outpatients.

 Specific objective 5: Evaluation of the social, environmental and economic impact determined
 by the proposed management system

 -  impact study: social (physical and mental health, religion contributions and
 technological development in the studied patient profile structure, interaction with
 public and private health and social institutions) and quantifying the influence of
 atmospheric pollution factors on the studied patients, risk maps depending on patient
 location;

 -  cost management model for the targeted patients, quantification of upstream and
 downstream costs reduction, general impact on the costs in the health system, the social
 system as well as the budget allocated from own sources by the patients / patients
 involved.
Inclusion Criteria:

 -  all known cardiovascular patients from local Cardiology Clinics, with:

 1. all spectrum of coronary syndromes (chronic to acute) +/- known coronary
 angioplasties;

 2. treated arterial hypertension;

 3. known congestive heart failure

 -  AND isolated / quarantined recommendations (due to COVID 19 pandemic).

 Exclusion Criteria:

 -  refusal / denial to create an electronic account on this dedicated platform;

 -  refusal to accept wearable devices (ecg watches, oximetry).