From the NELA President: Leveraging Telehealth to Reduce Cardiovascular Risk in the Era of COVID-19

“Necessity is the mother of invention.” – Plato

Welcome to this issue of LipidSpin. It was a pleasure to collaborate with SELA President Dr. Dave Dixon, who did a lot of the heavy lifting during the planning phase. I would also like to thank those who volunteered their time to write on the important topic of telehealth for cardiovascular disease management and prevention in these critical times.

A LipidSpin dedicated to telehealth was timely when we conceived it in mid-summer, as the second wave of the COVID-19 pandemic was upon us. Although regulatory barriers related to reimbursement and state telehealth laws had been lifted in March, and most of us had been engaging in phone or virtual visits with our patients for a few months, we had many questions. How could telehealth be tailored to improve adherence to both cardioprotective medications and lifestyles? How could telehealth be leveraged for team care by Lipid Specialist pharmacists, APPs, and RDNs in the current era? And, for those of us in fee-forservice environments, could telehealth be a catalyst for transitioning our health systems to more accountable care, as practiced in Kaiser Permanente and the Veterans Affairs health systems, where quality reporting and outreach have been used for years to improve the cardiovascular health of entire populations of patients? We envisioned this edition of the LipidSpin and slate of expert authors to help provide some of these answers.

Since then, leveraging telehealth in those with elevated cardiovascular risk has become even more urgent. Observational data from China, Europe, and the U.S. have shown that, except for age, the principal risks for poor outcomes from COVID-19 are modifiable diseases (coronary disease, DM2, obesity, and hypertension) that are strongly linked to physiologic and behavioral risk factors, driving home the importance of cardiovascular risk reduction. Yet, paradoxically, other survey data show that diet quality, weight control, physical inactivity, and cigarette smoking have worsened during the pandemic, possibly driven by unemployment, food insecurity, fewer venues for exercise, collective anxiety, and social isolation. These trends are especially concerning for the U.S., where almost 50% of adults are at increased risk of poor outcomes from COVID-19 due to chronic conditions like obesity and Type 2 diabetes, and where 50% of the adult population, especially those with lower socioeconomic status, already consumes a poor diet. Although not yet widely reported, lapses in health coverage and adherence to cardioprotective medications is no doubt also occurring.

Clearly, based on these data and the expected transition to a third and larger COVID-19 peak in the winter of 2020-21, we must double our efforts to provide education, behavioral counseling, and other selfmanagement support to reduce cardiovascular risk, and to develop clinical systems for quality improvement. Luckily, in the 21st century, telehealth visits, clinical decision support, patient portals, mobile health tools, virtual conferences, and dashboards can help us make this a reality. It’s time to apply the experiences of colleagues writing in this issue, best practices from integrated health systems and governmental initiatives, and emerging technologies to reduce upstream cardiovascular risks in our battle against COVID-19, and beyond.