P018. Case Study of Heart Failure Exacerbation Management via Tele-Health

Abstract

<h3>Background</h3> • 6.5 million American adults have heart failure • Advance Practice Providers (APP) can successfully manage CHF exacerbation via Tele-Health Case Study •HPI: 74-year-old male with a PMHx of ICM, HFrEF (EF 25-30%), HTN, HLD, obesity, OSA, hx of tobacco use and EtOH abuse. Cardiology consulted for worsening edema, weight gain, escalating SOB and DOE. • NP provided same day Tele-Health visit and diagnosed patient with CHF exacerbation. Treatment plan in alignment with Goal Direct Medical Therapy (GDMT) developed for inpatient diuresis. NP adapted plan for outpatient setting after patient refused admission citing concern for COVID-19. • Patient educated and performed in-home self-monitoring of weight and BP. Labs drawn in outpatient clinic. • NP tailored & provided close patient monitoring via weekly Tele-visits for 6-8 weeks thereafter bi-weekly visits and one F2F visit bundled with echocardiogram, additional PRN visits provided for symptomatic changes. <h3>Results</h3> Patient presented weighing 209lbs, diuresis to 180.8lbs (-28.2lbs) over 2 months. BNP decreased from 2534 to 496. <b>Labs:</b> Stable electrolytes/renal panel (K+4.2-4.9, Cr 0.99-1.21) throughout care. <b>QoL:</b> Minimal symptoms, no longer sleeping in recliner and improved energy level. <b>Plan:</b> Continue bi-weekly and PRN phone visits. Continue GDMT. Refers to cardiac catheterization and device/clinic for ICD/defibrillator evaluation. <h3>Conclusions</h3> This case occurred during the COVID-19 pandemic. The NP successfully provided outpatient management of a CHF exacerbation in accordance to GDMT via Tele-Health visits. To date patient is without hospitalization and symptomatically markedly improved. Overall optimizing patient safety, autonomy, and cost savings related to hospitalization.