ACC21 poster.pdf

A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population

Daniel Friedman, BA, Jana Goldberg, MD, Syed-Samar Raza, MD, Nodar Janas, MD, Pete Celano, MBA, Karen Kapoor, BS Jina Telaraja, MS, PAC, Maria Torres, BS, Adam Castaño, MD, MS, Mark Hanson, PhD, Nayan Jain, BS, Jeffrey Wessler, MD, MPhil

CARDIOLOGY

Background

Heart failure (HF) is a common and costly diagnosis in skilled nursing facility (SNF) patients.

300,000+ SNF patients

300,000+ SNF patients carrying a heart failure diagnosis

27% to 43% 30-day readmission rate

27% to 43% 30-day readmission rate for SNF patients receiving usual care

$9,051 per readmission

for an average heart failure readmission

RESEARCH QUESTION

Could a virtual cardiovascular care program reduce the 30-day readmission rate for HF patients discharged to SNF relative to the expected rate for this population?

SNFs in New York City were disproportionately affected by COVID-19. Improved access to specialty care through a virtual medium also represented an opportunity to decrease patient infection risk.

Methods

C+

Heartbeat Health (HBH), a digital health company, developed and implemented a virtual cardiovascular care program for 11 SNFs in New York.

Cardiac patients identified by SNF care team and enrolled.

人

HBH televisit with cardiologist via smartphone, tablet, or laptop.

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Post-consult care plans given to SNF clinical staff.

Additional televisits as clinically indicated.

A retrospective case review of patients between Aug 2020 and Feb 2021 was performed.

n=185 Patients with CHF diagnosis discharged to SNF following hospitalization
n=45 Received≥1 consult n=140 Index admission≠CHF; Consult after30days;Comfort care
n=40 Analyzed n=5 Lost to follow up(discharged home within30days of SNF arrival)

Results

Among the 40 patients who were analyzed, baseline comorbidities were typical of an older SNF population.

65% had one virtual consultation while 35% had more than one. Additional consults were called by SNF medical staff or at cardiologist discretion for:

Volume management

BASELINE CHARACTERISTICS

Blood pressure control

Age(in years) 80.5 (10.4)
Ejection Fraction(in %) 41.6 (17.9)
Systolic BP(in mmHg) 127.5 (19.4)
Diastolic BP(in mmHg) 67.7 (9.6)
Sex Female 20 (50%)
Race Black 11 (28%)
Race Hispanic 2 (5%)
Race Asian 1 (3%)
Race White 26 (65%)
HF Type HFrEF 21 (53%)
HF Type HFpEF 16 (40%)
HF Type Unknown 3 (8%)
NYHA Class I 0 (0%)
NYHA Class II-III 37 (93%)
NYHA Class IV 3 (8%)
CAD 17 (43%)
Hypertension 38 (95%)
Diabetes 10 (25%)
CKD 15 (38%)

Number of Virtual Consults Per Patient

Mean (SD) or N (%)

Readmission rates were lower for patients who received at least 1 virtual consultation compared to the expected readmission rates with usual care for both all-cause and cardiac readmissions.

Readmission Rate by Cause

Reduced expected readmission rate may decrease expected costs per patient.

Black patients were significantly more likely to be readmitted than white patients (OR: 9.21; 95% CI: 1.17 to 119.50), a disparity consistent with previous research examining HF readmission rates that must be addressed.

CONCLUSION

Virtual cardiovascular care consultation within 30 days for HF patients discharged to SNF may lower readmission rates relative to expected rates for this population.

Discussion

Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

Potential Virtual Care Benefits

SNF Patients & SNFs

Remote Providers

Healthcare System

Limitations

Disclosures & References