PHILADELPHIA – For patients transitioning to home after a heart failure hospitalization, substituting in-person visits with virtual, video-based visits is feasible, safe, and may reduce appointment no-show rates, results of a randomized study suggest.
Connecting patients with clinicians over secure video cut no-show rates at 7 days post-discharge by about one-third, with no difference in risk of readmission, emergency department visits, or death, compared with the traditional in-person follow-up visit, investigator Eiran Z. Gorodeski, MD, MPH, reported here at the annual scientific meeting of the Heart Failure Society of America.
Dr. Eiran Gorodeski
While the video meet-up doesn’t allow for a physical exam, it’s still possible to collect history of what happened since hospital discharge, assess breathing, and complete other aspects of the follow-up visit, according to Dr. Gorodeski, director of advanced heart failure section at the University Hospitals Cleveland Medical Center.
“The way we view use of virtual visits 7 days post-discharge is, in many ways, as a screening platform,” he said in a panel discussion. “If someone seems to be doing poorly, you can always invite them to come in, but most patients post discharge are not congested, and they’re doing quite well. Probably the more relevant issues are things like: Do they have their medications? Do they understand what their follow-up appointments are?”
During the virtual visit, patients are asked to hold their medication bottles up to the camera so the clinician can see what they are taking.
“Frequently, we are able to catch mistakes,” Dr. Gorodeski said. “Of note, most patients don’t bring their pill bottles to the clinic, so in some ways doing the virtual visit for that aspect was more valuable.”
Patients who opt for a virtual visit can do so from any smart phone, laptop, or desktop computer. Once logged in, they enter a virtual waiting room as the clinician receives a text notification to log in and begin the visit.
“It’s very efficient with time, and my questions were answered quickly,” said a patient in a short video Dr. Gorodeski played to illustrate the technology.
“I still feel the same connectivity with the patient,” a clinician in the video said.
There is currently no way to bill insurance companies for this type of visit, Dr. Gorodeski said when asked what initial barriers other institutions might have implementing a similar approach.
In the randomized, single-center clinical trial Dr. Gorodeski presented here at the HFSA meeting, called VIV-HF (Virtual Visits in Heart Failure Care Transitions), a total of 108 patients were randomized to the virtual visit (52 patients) or an in-person visit (56 patients).
The majority of patients (over 60%) had heart failure with reduced ejection fraction, according to the reported study results.
No-show rates were 50% for the in-person visit, and 34.6% for the virtual visit, for a relative risk reduction of 31%. However, this difference did not reach statistical significance, likely because the study was underpowered, according to Dr. Gorodeski.
“This strategy may reduce postdischarge appointment no-show rates, and this needs to be studied further in larger and appropriately powered clinical trials,” he said in presenting the results.
The 7-day postdischarge outpatient clinic visit is recommended in guidelines and viewed as a way to increase care engagement while reducing risk of poor outcomes, according to VIV-HF investigators.
Support for the study came from the Hunnell Fund. Dr. Gorodeski reported being a consultant and advisor to Abbott.
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SOURCE: Gorodeski EZ, et al. HFSA 2019. Late-Breaking Clinical Trials session.