Telehealth-aided outpatient management of acute heart failure in a specialist virtual ward compared with standard care.

Abstract

The aim of this propensity score matched cohort study was to assess the outcomes of telehealth-guided outpatient management of acute heart failure (HF) in our virtual ward (HFVW) compared with hospitalized acute HF patients. This cohort study (May 2022-October 2023) assessed outcomes of telehealth-guided outpatient acute HF management using bolus intravenous furosemide in a HF-specialist VW. Propensity score matching (PSM) was performed using logistic regression to adjust for potential differences in baseline patient characteristics between HFVW and standard care [Get With The Guidelines-HF score, clinical frailty score (CFS), Charlson co-morbidity index (CCI), NT-proBNP, and ejection fraction]. Clinical outcomes (re-hospitalizations and mortality) were compared at 1, 3, 6, and 12months versus standard care-SC (acute HF patients managed without telehealth in 2021). Five hundred fifty-four HFVW ADHF patients (age 73.1±10.9years; 46% female) were compared with 404 ADHF patients (74.2±11.8; P=0.15 and 49% female) in the standard care-SC cohort. After propensity score matching for baseline patient characteristics, re-hospitalizations were significantly lower in the HFVW compared with SC (1month-HFVW 8.6% vs. SC-21.5%, P<0.001; 3months-21% vs. 30%, P=0.003; 6months-28% vs 41%, P<0.001 and 12months-47% vs. 57%, P=0.005) and mortality was also lower at 1month (5% vs. 13.7%; P<0.001), 3months (9.5% vs. 15%; P=0.001), 6months (15% vs. 21%; P=0.03), and 12months (20% vs. 26%; P=0.04). Multivariate logistic regression analysis showed that compared with standard care, HFVW management was associated with lower odds of readmission (1-month odds ratio (OR)=0.3 [95% Confidence Interval CI 0.2-0.5], P<0.0001; 3month OR=0.15 [0.1-0.3], P<0.0001; 6-month OR=0.35 [0.2-0.6], P=0.0002; 12-month OR=0.25 [0.15-0.4], P≤0.001 and mortality (1-month OR=0.26 [0.14-0.48], P<0.0001; 3-month OR=0.11 [0.04-0.27], P<0.0001; 6-month OR=0.35, [0.2; 0.61], P=0.0002; 12-month OR=0.6 [0.48; 0.73], P=0.03. Higher GWTG-HF score independently predicted increased odds of re-hospitalization (1-month OR=1.2 [1.1-1.3], P<0.001; 3-month OR=1.5 [1.37; 1.64], P<0.0001; 6-month OR=1.3 [1.2-1.4], P<0.0001; 12-month OR=1.1 [1.05-1.2], P=0.03) as well as mortality (1-month OR=1.21 [1.1-1.3], P<0.0001; 3-month OR=1.3 [1.2-1.4], P<0.0001; 6-month OR=1.2 [1.1-1.3], P<0.0001; 12-month OR=1.3 [1.1-1.7], P=0.02). Similarly higher CFS also independently predicted increased odds of re-hospitalizations (1-month OR=1.9 [1.5-2.4], P<0.0001; 3-month OR=1.8 [1.3-2.4], P=0.0003; 6-month OR=1.4 [1.1-1.8], P=0.015; 12-month OR 1.9 [1.2-3], P=0.01]) and mortality (1-month OR=2.1 [1.6-2.8], P<0.0001; 3-month OR=1.8 [1.2-2.6], P=0.006; 6-month OR=2.34 [1.51-5.6], P=0.0001; 12-month OR=2.6 [1.6-7], P=0.02). Increased daily step count while on HFVW independently predicted reduced odds of re-hospitalizations (1-month OR=0.85[0.7-0.9], P=0.005), 3-month OR=0.95 [0.93-0.98], P=0.003 and 1-month mortality (OR=0.85 [0.7-0.95], P=0.01), whereas CCI predicted adverse 12-month outcomes (OR=1.2 [1.1-1.4], P=0.03). Telehealth-guided specialist HFVW management for ADHF may offer a safe and efficacious alternative to hospitalization in suitable patients. Daily step count in HFVW can help predict risk of short-term adverse clinical outcomes.