Utility of Remote Monitoring and Telemedicine in Lung Transplant Recipients During COVID19 Pandemic Restrictions

Abstract

Introduction: COVID19 pandemic has led to a significant increase in telemedicine utilization due to risk of healthcare acquired infection. Lung transplant recipients are high risk for infection and have extraordinary health care needs. The HGE remote symptom monitoring has been shown to be beneficial in COPD patients to decrease exacerbations and time to treatment1-8. During peak pandemic restrictions we transitioned to a telemedicine only system and patients were encouraged to enroll in the “HGE COVIDCare” for reporting daily symptoms suspicious for COVID19. With a combination of remote symptom monitoring and telemedicine, we aimed to provide early intervention and necessary care, while decreasing the risk of infection. This study assesses the feasibility and short-term outcomes of using this combination in lung transplant recipients. Methods: Single center, retrospective study of lung transplant recipients of who were enrolled in the HGE COVIDCare symptoms tracker program in March 2020. Pre-pandemic data was collected prior to March 15 and post pandemic restriction data was collected after July 15th, 2020. Patients were asked to report daily symptoms via HGE-COVID website, which was triaged by transplant nurses. We recorded self-reported symptoms from the symptom tracker, details of tele medicine visits and hospitalizations, and changes in pulmonary function tests. Results: The first 50 lung transplant recipients enrolled were included in this short-term analysis with most patients within one-year post transplant (66%). During the four-month pandemic restriction, 6 patients (12%) had “symptom events” reported via the tracker. None of the symptoms were due to COVID19. Etiologies included pneumonia, bronchial stenosis, diarrhea due to C diff and medication or symptoms self-resolving prior to team outreach. 8 patients (16%) were admitted to the hospital for non COVID indications and 2 patients died during this period due to sepsis. Post pandemic limitation PFTs were available for 35 (70%) patients. None of the patients had a decline in PFTs, compared to the “pre pandemic” values. The incidence of hospitalization or acute rejection was similar in the months preceding the pandemic compared to the 4-month pandemic restriction period. Conclusions: In lung transplant recipients, a combination of telemedicine and remote symptom monitoring is feasible and safe. It did not lead to increased rate of hospitalization, acute rejection or worsening lung function in this short term follow up. This model could be potentially followed to help decrease risk of healthcare acquired infections, patient visits and health care costs without impacting outcomes. .