P252 PROTOCOL FOR TELEHEALTH MANAGEMENT AND STRATIFICATION RISK OF ELDERLY PATIENTS WITH CHRONIC HEART FAILURE DURING THE COVID–19 PANDEMIC: A MID–TERM PROGNOSTIC EVALUTATION BY TELEHFCOVID–19 SCORE

Abstract

IntroductionThe Coronavirus Disease (COVID–19) pandemic and its consequences has forced physicians to develop telematic methods in order to follow up patients with cronic diseases, such as heart failure (HF).ObjectivesTo evaluate TeleHFCovid–19 score as a mid–term (six months) prognostic score in terms of prediction of hospitalitazion and cardiovascular mortality in patients with chronic HF during Covid–19 pandemic.MethodsDuring COVID–19 pandemic (from March 2020 to May 2020), we were forced to cancel nearly all follow–up checks in our HF outpatient clinic. We hence standardized a telephone follow–up by developing a questionnaire (Fig. 1) from which we then obtained a score, later called the “TeleHFCovid–19 score” (0–29). This score stratified patients in three risk score groups: green (0–3), yellow (4–8), and red (≥9), for which the next telefonic evaluation was planned after 4, 2 and 1 weeks, respectively.Results146 patients were enrolled: 112 were classified as green, 21 as yellow and 13 as red. Mean age was 81 years, females were 40%. Approximately one third had EF < 40%. At six months, compared to red (69.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization, (p < 0.001, Fig 2). Multivariate analysis showed that high levels of creatinine (OR 5.960, 95% CI 1.627–21.837, p = 0.007), dyspnea at rest or for basic activities (OR 2.469, 95% CI 1.216–5.013, p = 0.012) and a high loop–diuretic dosage (OR 6.224, 95% CI 1.504–25.753, p = 0.012) were indipendently associated with the outcome. Moreover, ROC analysis showed a high sensibility and specificity for our score at six months (AUC =0.789, 95% CI 0.682–0.896, p < 0.001), with a score < 4.5 (very close to the green group cut–off) that identified lower–risk subjects (Fig 3).ConclusionsThe TeleHFCovid–19 score was able to correctly identify patients with good outcomes at six months. Furthermore, it has the ability to stratify the adverse event risk and this could represent a useful tool to appropriately schedule the reevaluation timing of these patients and to identify those who may need urgent hospital evaluation.