The Utility of Televisits in Patients with a Left Ventricular Assist Device

Abstract

<h3>Purpose</h3> Televisits are an alternative method of patient assessment and monitoring used to replace or complement traditional clinic visits. The aim of this study was to assess the utility and effectiveness of televisits in LVAD patients. <h3>Methods</h3> Prospective cohort study of consecutive LVAD patients undergoing televisits between March 1st and May 30^th, 2020 in a large academic medical center. Patient demographics, baseline medications, and details of televisit encounters were collected from electronic medical records. Patients were followed for 3-months from their initial televisit for medication changes, in-person visits, hospital admissions and mortality. <h3>Results</h3> 133 patients were enrolled; Mean age was 60.9 (±14.6) years and 111 (83.5%) were male. Mean time between LVAD implantation and first televisit was 33.6 months. The number of televisits per patient varied from 1-7 with the majority (45.1%) having 2 televisits during the study period. (Figure 1a). 86 patients (64.7%) had medication changes, primarily warfarin (82.6 %) followed by diuretics (31.4%). 63 patients (47.4%) visited the hospital in person for an urgent clinic visit or a right heart catheterization (Figure 1b). 21 patients (15.8%) had at least one admission to the hospital (total 29 admissions). 3 patients (2.3%) died (1 from sepsis and 2 from heart failure (HF) secondary to aortic regurgitation). Of the hospital admissions, 11 occurred within two weeks of televisits (37.9%). Admissions were due to infection in 8 (27.6%), HF in 5 (17.2%), arrythmia/syncope in 4 (13.8%), heart transplantation in 2 (6.9%), gastrointestinal bleeding in 2 (6.9%), LVAD alarms in 1 (3.4%) stroke in 1 (3.4%) and other causes in 6 (20.7%) <h3>Conclusion</h3> Televisits are a viable strategy for management of LVAD patients leading to significant changes in anticoagulation and diuretic management. However, the high complexity of LVAD patients together with their severity of their illness results in multiple person clinic visits, admissions, and incidences of death.