Remote Patient Monitoring of Blood Pressure Is Feasible Poststroke and Can Facilitate Triage of Care.

Background and Purpose: Strict blood pressure (BP) control is a universally accepted therapeutic intervention in the prevention of secondary stroke, yet this remains difficult when patients return home postinjury. This study aimed to investigate the application of the remote patient monitoring (RPM) of BP in patients after stroke, or who were at immediate risk of stroke, and the subsequent outcomes relating to triage and escalation of care. Methods: This was a single-center proof-of-concept study. Participants were patients aged 18 years and older with a diagnosis of stroke or who were at immediate risk of stroke. Patients were enrolled into the precision recovery program (PRP) and asked to assess their BP and heart rate daily and enter values into a MyCap application for the RPM program. These data were reviewed daily by an assigned PRP clinician, and weekly Zoom meetings were held with the patient. Care was triaged and escalated to a physician as indicated. Results: Twelve patients (5 [42%] female, aged mean [range] 63 [43-84] years) met the inclusion criteria and continued in the program for median (range) 136 (8-227) days. The median (range) number of excursions of BP above limits per participant was 19 (0-79) for systolic and 36 (0-104) for diastolic. A total of 16 triage events (median [range] 1 [0-3]) were initiated for escalation of care. Conclusions: This study demonstrated that RPM is feasible in patients poststroke or at immediate risk of stroke, and facilitates the triage of care when BP is elevated above recommended limits.

Post-acute COVID-19 Syndrome Negatively Impacts Physical Function, Cognitive Function, Health-Related Quality of Life, and Participation.

OBJECTIVE: This report describes persistent symptoms associated with post-acute COVID-19 syndrome (PACS) and the impact of these symptoms on physical function, cognitive function, health-related quality of life, and participation. DESIGN: This study used a cross-sectional observational study design. Patients attending Mount Sinai's post-acute COVID-19 syndrome clinic completed surveys containing patient-reported outcomes. RESULTS: A total of 156 patients completed the survey, at a median (range) time of 351 days (82-457 days) after COVID-19 infection. All patients were prevaccination. The most common persistent symptoms reported were fatigue (n = 128, 82%), brain fog (n = 105, 67%), and headache (n = 94, 60%). The most common triggers of symptom exacerbation were physical exertion (n = 134, 86%), stress (n = 107, 69%), and dehydration (n = 77, 49%). Increased levels of fatigue (Fatigue Severity Scale) and dyspnea (Medical Research Council) were reported, alongside reductions in levels of regularly completed physical activity. Ninety-eight patients (63%) scored for at least mild cognitive impairment (Neuro-Qol), and the domain of the EuroQol: 5 dimension, 5 level most impacted was Self-care, Anxiety/Depression and Usual Activities. CONCLUSIONS: Persistent symptoms associated with post-acute COVID-19 syndrome seem to impact physical and cognitive function, health-related quality of life, and participation in society. More research is needed to further clarify the relationship between COVID-19 infection and post-acute COVID-19 syndrome symptoms, the underlying mechanisms, and treatment options.

Remote Patient Monitoring Identifies the Need for Triage in Patients with Acute COVID-19 Infection.

Introduction: Telehealth was frequently used in the provision of care and remote patient monitoring (RPM) during the COVID-19 pandemic. The Precision Recovery Program (PRP) remotely monitored and supported patients with COVID-19 in their home environment. Materials and Methods: This was a single-center retrospective cohort study reviewing data acquired from the PRP clinical initiative. Results: Of the 679 patients enrolled in the PRP, 156 patients were screened by a clinician following a deterioration in symptoms and vital signs on a total of 240 occasions, and included in the analyses. Of these 240 occasions, 162 (67%) were escalated to the PRP physician. Thirty-six patients were referred to emergency department, with 12 (7%) admitted to the hospital. The most common risk factors coinciding with hospital admissions were cardiac (67%), age >65 (42%), obesity (25%), and pulmonary (17%). The most common symptoms reported that triggered a screening event were dyspnea/tachypnea (27%), chest pain (14%), and gastrointestinal issues (8%). Vital signs that commonly triggered a screening event were pulse oximetry (15%), heart rate (11%), and temperature (9%). Discussion: Common factors (risk factors, vital signs, and symptoms) among patients requiring screening, triage, and hospitalization were identified, providing clinicians with further information to support decision making when utilizing RPM in this cohort. Conclusion: A clinician-led RPM program for patients with acute COVID-19 infection provided supportive care and screening for deterioration. Similar models should be considered for implementation in COVID-19 cohorts and other conditions at risk of rapid clinical deterioration in the home setting.

Remote Patient Monitoring for Home Management of Coronavirus Disease 2019 in New York: A Cross-Sectional Observational Study.

Background: Coronavirus disease 2019 (COVID-19) poses a global public health emergency, overwhelming health systems worldwide and forcing rapid adoption of telemedicine strategies. Introduction: The COVID-19 Precision Recovery Program (PRP) is a remote patient monitoring (RPM) clinical program that was deployed by a New York health system to perform physiologic and symptomatic monitoring for patients with confirmed or suspected COVID-19 diagnoses. Methods: The present cross-sectional descriptive study reports retrospective data collected from the PRP during the COVID-19 crisis in New York. Results: One hundred twelve patients were included; mean (standard deviation) age was 49 (17.6) years and 60.7% were female. Most prevalent reported comorbidities were hypertension (36.3%), hypercholesterolemia (26.5%), and diabetes (17.7%). Less than half (44.6%) had a positive polymerase chain reaction COVID test (PCR-test), 33% had an unknown COVID status, and 17.9% had a negative test result. The most commonly reported symptoms included dyspnea (55.4%) and anxiety (55.4%). Anxiety was ranked as the most severe symptom (9.8%), followed by difficulty concentrating (4.5%). Symptom presentation did not significantly differ based on PCR-test status. Discussion: RPM can be a valuable tool for delivering care to patients with confirmed or suspected COVID-19 diagnoses. Considering similarities in symptom presentation between PCR-test statuses, access to COVID-related clinical care should not be based on PCR-test results. Conclusions: RPM has strong potential to assist in the effective management of suspected COVID-19 patients.