Telemedicine and Remote Monitoring as an Adjunct to Medical Management of Bronchiectasis

The limited resources and the practice of social distancing during the COVID pandemic create a paradigm shift in the utilization of telemedicine in healthcare. However, the implementation of best practices is hampered in part by a lack of literature devoted to telehealth in bronchiectasis. In this commentary, we examine multiple approaches to structuring of telemedicine care for patients with bronchiectasis, highlight current evidence-based interventions that can be incorporated into the management of bronchiectasis, and describe our experience with telemedicine at the University of Connecticut Center for Bronchiectasis Care during the COVID-19 pandemic. The structural model must be adapted to different local dynamics and available technologies with careful attention to patient characteristics and access to technology to avoid the potential paradoxical effects of increasing patients’ burden and healthcare disparities in underserved populations

Post-COVID-19 Condition and Health Status

Background: Observational studies of the long-term effects of COVID-19 infection generally focus on individual symptoms rather than health status. Objective: Longitudinal assessment of general health status following COVID-19 infection. Design: Observational study, with data collected from two telephone surveys at 32 ± 10 and 89 ± 25 days after discharge from the hospital or emergency department (ED) for a COVID-19 infection. Medicaid or no insurance was our marker of low socioeconomic status (SES). Acute disease severity was determined by summing 10 severity markers (yes-no) from the health encounter. Baseline comorbidity was a modified Charlson Index. Participants: 40 patients. Mean age was 54 ± 15 years, 50% were female, and 40% had low socioeconomic status. Main Measures: (1) the 20-item Medical Outcomes Study Short-Form General Health Survey (SF-20); (2) Dyspnea (modified Medical Research Council); (3) Psychological symptoms (Patient Health Questionnaire for Anxiety and Depression); (4) Cognitive function (Cognitive Change Questionnaire); (5) Fatigue (Short Fatigue Questionnaire); (6) A 10-item review of systems (ROS) questionnaire. Key Results: Percentages with abnormal symptoms at the first and second surveys were (respectively): Dyspnea (40, 33), Fatigue (53, 50), Anxiety (33, 18), Depression (20, 10), PHQ-4 Composite (25, 13), and Cognitive (18, 10). Mean scores on the SF-20 subscales, Physical Functioning, Role Functioning, Social Functioning, Health Perception, Mental Health, and Pain were numerically lower than means from a published study of elderly outpatients. With the exception of Pain, all SF-20 subscale scores improved significantly by the second survey. In multivariable analyses, dyspnea was predictive of impairment in all SF-20 subscales at the second survey. Conclusions: COVID-19 infection causes persistent abnormality across multiple patient-reported outcome areas, including health status. The persistence of impairment in each health status component is influenced by baseline dyspnea

Effect of Obstructive Sleep Apnea and Its Treatment of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation: A Meta-Analysis

Background/objectives: Patients with obstructive sleep apnea (OSA) have an increased the risk of developing atrial fibrillation (AF). However, it remains unclear if patients with OSA carry a higher risk of recurrent AF after successful catheter ablation. This meta-analysis was conducted (1) to evaluate the association between OSA and recurrent AF after catheter ablation, and (2) to assess the effect of continuous positive airway pressure (CPAP) on the risk of recurrent AF in patients with OSA. Methods: A comprehensive literature review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through July 2017 to identify studies that evaluated the risk of recurrent AF after successful catheter ablation in patients with OSA were included. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Seven observational studies with a total of 4572 patients AF after successful catheter ablation were enrolled. Compared to patients without OSA, the pooled OR of recurrent AF in patients with OSA was 1.70 (95% CI, 1.40-2.06, I2 = 0). Among OSA patients with AF after successful catheter ablation, the use of CPAP was significantly associated with decreased risk of recurrent AF with pooled OR of 0.28 (0.19-0.40, I2= 0). Egger\u27s regression asymmetry test was performed and showed no publication bias for the associations of OSA and CPAP with recurrent AF. Conclusions: Our meta-analysis suggested a significant association between OSA and recurrent AF after catheter ablation. The use of CPAP in patients with OSA is associated with reduced risk of recurrent AF after catheter ablation