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

• Published in: JMIR cardio 2021-06, Vol.5 (1), p.e29101-e29101
• Main Authors: Friedman, Daniel M, Goldberg, Jana M, Molinsky, Rebecca L, Hanson, Mark A, Castaño, Adam, Raza, Syed-Samar, Janas, Nodar, Celano, Peter, Kapoor, Karen, Telaraja, Jina, Torres, Maria L, Jain, Nayan, Wessler, Jeffrey D
• Format: Article
• Language: English
• Subjects: Cardiology; Cost control; COVID-19; Edema; Emergency medical care; Health care expenditures; Health care policy; Heart failure; Hospitals; Infectious diseases; Influenza; Literacy; Medicaid; Medicare; Nurses; Nursing; Original Paper; Pandemics; Patients; Population; Severe acute respiratory syndrome coronavirus 2; Software; Telemedicine
• ISSN: 2561-1011; 2561-1011
• DOI: 10.2196/29101

Background: Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. Objective: The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. Methods: We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. Results: We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient. Conclusions: The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.