Addressing Secondary Death from the COVID Pandemic: Untreated Heart Disease
On Wednesday March 18, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that all elective surgery and procedures should be delayed during the COVID outbreak. This timely effort at containment and resource preservation will result in the delay of care for patients suffering with a variety of conditions. For patients with severe valvular heart disease, the delay could be deadly.
The COVID-19 virus pandemic will have a lasting impact on our healthcare system. Almost instantaneously following the CMS announcement there was a precipitous fall in the number of echocardiograms performed at U.S hospitals. Tens of thousands of patients with heart valve disease immediately lost access to a time-sensitive and crucial diagnostic study. As the driver of decision making for everything from adjusted medical management to heart transplantation, the sudden fall in echocardiography introduces delay in an area of heart care where undertreatment has been a longstanding issue.
Surgical and procedural volumes have also dropped precipitously, creating a new phenomenon in the U.S.- waiting lists.
When the dust settles after the acute phase of this pandemic, our planning today will be the differentiator during reactivation of our heart centers and we will reap large rewards for our patients awaiting critical intervention.
There are several key challenges that must be met. First, we must solve how to identify and account for all patients that have been deferred for echocardiography. The scale of this problem exceeds the ability of human capacity and must be solved with algorithmic methods. Similarly, the second challenge is how to prioritize patients and procedures from the rapidly growing backlog and waiting lists.
While there is no substitution for expert clinical judgment, new tools that augment and scale physician abilities will allow us to scale expertise in a manner not previously possible. The third challenge is communication with our patients during this time, which going forward must be enhanced. The rapid growth and acceptance of telehealth visits reminds us of our patients’ hunger for information, especially in times of uncertainty. Unique forms of communication will be deployed to enhance our ability to serve our patients.
Focused attention to our changing environment and adaptation through innovation is already producing the tools needed for us to continue to deliver high value healthcare. Our data-rich healthcare systems can use these tools during this crisis and beyond to drive growth and value. The result will be better care for patients at scale following COVID-19.
Mpirik has been focused on these challenges since the news broke and is committed to helping their hospital accounts adapt. To better understand the approach Mpirik is taking to tackle these challenges, it’s helpful to consider the data and utility Mpirik provides healthcare organizations.
Mpirik’s Cardiac Intelligence™ software analyzes echocardiogram reports to identify patients with characteristics of cardiac disease. Diagnostic results from the hospital EMR are securely transferred in realtime to Mpirik, organized using Natural Language Processing (NLP), and analyzed by Mpirik’s algorithms for criteria of cardiovascular diseases. Every patient is then tracked longitudinally for presence of proper treatment plans and follow up care, and in the case that care is not provided, hospital staff can utilize Mpirik’s web based portal to manage these patients and ensure a timely referral or follow up is executed. The primary focus is to help the cardiovascular service lines improve their cardiovascular disease detection, while also tracking patients through the progression of the disease to eliminate undertreatment.
This unique and up-to-date data set provides Mpirik with an unprecedented opportunity to respond to COVID-19’s effect on heart disease, while at the same time provide the necessary tools to help heart teams treat patients in a timely manner.
The first goal was to organize all patients currently identified with a severe structural heart disease and isolate all patients that have not received treatment. This population was then assessed based on echocardiogram data and EHR data previously transferred to Mpirik in order to prioritize the patients based on their individual need for treatment. Two ranking approaches were implemented: a discrete 3-tiered system, and a continuous weighted ranking system. The weighted rank orders the patients from most severe (needing treatment as soon as possible) to least severe. The discrete 3-tiered system sorts patients based on their severity and need for treatment (Mild, Moderate, and Severe).
Before the prevalence of COVID-19 and its disruption to the scheduling of elective procedures, a logistic regression and survival analysis revealed certain comorbidities as risk factors for hospitalization and intervention. Additionally, a separate analysis revealed that the number of comorbidities a patient has affects hemodynamics and can predict measurements such as Ejection Fraction. These two research outcomes informed our variable selection and methodology in developing our ranking approaches. For both ranking systems, we included echocardiogram-measured hemodynamics, comorbidities, patient demographics, body surface area, and changes in echocardiogram values over time (speed of progression). The rationale for using these measurements were to leverage information about the trajectory of a patient’s heart health in addition to the most recent snapshot of the patient’s valvular hemodynamics. Mpirik then took the results back to three clinical champions from three separate institutions to evaluate the accuracy of the model against their clinical judgement.
Through feedback and several iterations, the model was refined and the results proved to align with the clinician’s point of view. Not only were both ranking systems reliably consistent with each other; the patients that Mpirik ranked as needing care immediately were also identified by clinicians as high-risk.
Because Cardiac Intelligence™ is a cloud-based solution and Mpirik’s development team leverages modern continuous deployment methodologies, the model could be implemented to all Mpirik’s hospital accounts within hours.
The Mpirik team is continuing to apply this approach to the tracking of moderate and mild severity of structural heart disease patients with the aim to track follow up echocardiogram adherence and ultimately produce the same prioritization tool.
Furthermore, Mpirik’s auxiliary commercialized products provide novel communication services that allow caregivers to asynchronously communicate with patients and their loved ones, while also soliciting secure feedback from patients. As communication with patients becomes all the more difficult to manage at scale, an intelligent and nuanced technology solution can augment the communication from the heart team, helping patients feel connected, informed, and heard.
The COVID-19 pandemic has already catalyzed a massive new adoption of technology in healthcare. Experienced, clinician-led teams like Mpirik are positioned to help usher the new era of healthcare, and are committed to providing exceptional solutions for clinicians and their patients.
To learn more visit Mpirik’s website or contact us at firstname.lastname@example.org