Meeting News

Virtual visits feasible for patients transitioning to home after HF: ViV-HF

PHILADELPHIA — The Virtual Visits and Heart Failure Care Transition, or ViV-HF, trial proved the feasibility of substituting inpatient visits with virtual visits for patients transitioning from hospital to home after hospitalization for HF, according to findings presented at the Heart Failure Society of America Scientific Meeting.

“This strategy led to a reduction in no-show rates, [but] that reduction was not statistically significant, likely due to lower than anticipated event rates in the control arm suggesting that the study was underpowered,” Eiran Z. Gorodeski, MD, MPH, director of the advanced heart failure section at University Hospitals Cleveland Medical Center and associate professor of medicine at Case Western Reserve University School of Medicine, said during his presentation. “There were no differences in the risk of possible readmission, ER visit or death between the groups.”

The researchers found an RR reduction of 31% (RR = 0.69; 95% CI, 0.44-1.09). However, due to lower than anticipated event rates in the control arm, the study was found to be underpowered and these findings were determined not significant.

Moreover, there were no significant differences between the two arms of the study at 45 days after discharge, according to presented results.

“The study aims were to assess the feasibility of substituting inpatient visits with virtual visits in patients transitioning home after hospitalization for heart failure; assess to what degree virtual visits can reduce appointment no-show rates, and assess the impact of virtual visits on clinical outcomes,” Gorodeski said.

In this pragmatic, randomized, single-center clinical trial, researchers assigned patients with HF to virtual visit (n = 52; mean age, 57 years; 58% men; 65% white; 23% with Medicaid insurance; 8% with cognitive impairment) or in-person visit groups (n = 56; mean age, 63 years; 50% men; 68% white; 20% with Medicaid insurance; 20% with cognitive impairment). The primary outcome of the study was appointment no-show rates at 7 days after discharge. The clinical outcomes, both composite and individual, were hospital readmission, ED visit and death.

“Our [results] suggests that a strategy of postdischarge virtual visits for patients who were hospitalized for heart failure may be safe, may reduce postdischarge appointment no-show rates and needs to be studied further in larger, appropriately powered clinical trials,” Gorodeski concluded. – by Scott Buzby

Reference:

Gorodeski E, et al. Late Breaking Clinical Trials. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 13-16, 2019; Philadelphia.

Disclosure: The study was funded by a philanthropic gift to Cleveland Clinic from the Hunnell Fund. Gorodeski reports he is a consultant and advisory board member for Abbott.

Editor's Note: This article was updated on Sep. 17, 2019 to indicate that the Hunnell Fund is the funding source for this study, not Abbott, and that Gorodeski is currently employed at University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, not Cleveland Clinic. The Editors regret the error.

PHILADELPHIA — The Virtual Visits and Heart Failure Care Transition, or ViV-HF, trial proved the feasibility of substituting inpatient visits with virtual visits for patients transitioning from hospital to home after hospitalization for HF, according to findings presented at the Heart Failure Society of America Scientific Meeting.

“This strategy led to a reduction in no-show rates, [but] that reduction was not statistically significant, likely due to lower than anticipated event rates in the control arm suggesting that the study was underpowered,” Eiran Z. Gorodeski, MD, MPH, director of the advanced heart failure section at University Hospitals Cleveland Medical Center and associate professor of medicine at Case Western Reserve University School of Medicine, said during his presentation. “There were no differences in the risk of possible readmission, ER visit or death between the groups.”

The researchers found an RR reduction of 31% (RR = 0.69; 95% CI, 0.44-1.09). However, due to lower than anticipated event rates in the control arm, the study was found to be underpowered and these findings were determined not significant.

Moreover, there were no significant differences between the two arms of the study at 45 days after discharge, according to presented results.

“The study aims were to assess the feasibility of substituting inpatient visits with virtual visits in patients transitioning home after hospitalization for heart failure; assess to what degree virtual visits can reduce appointment no-show rates, and assess the impact of virtual visits on clinical outcomes,” Gorodeski said.

In this pragmatic, randomized, single-center clinical trial, researchers assigned patients with HF to virtual visit (n = 52; mean age, 57 years; 58% men; 65% white; 23% with Medicaid insurance; 8% with cognitive impairment) or in-person visit groups (n = 56; mean age, 63 years; 50% men; 68% white; 20% with Medicaid insurance; 20% with cognitive impairment). The primary outcome of the study was appointment no-show rates at 7 days after discharge. The clinical outcomes, both composite and individual, were hospital readmission, ED visit and death.

“Our [results] suggests that a strategy of postdischarge virtual visits for patients who were hospitalized for heart failure may be safe, may reduce postdischarge appointment no-show rates and needs to be studied further in larger, appropriately powered clinical trials,” Gorodeski concluded. – by Scott Buzby

Reference:

Gorodeski E, et al. Late Breaking Clinical Trials. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 13-16, 2019; Philadelphia.

Disclosure: The study was funded by a philanthropic gift to Cleveland Clinic from the Hunnell Fund. Gorodeski reports he is a consultant and advisory board member for Abbott.

Editor's Note: This article was updated on Sep. 17, 2019 to indicate that the Hunnell Fund is the funding source for this study, not Abbott, and that Gorodeski is currently employed at University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, not Cleveland Clinic. The Editors regret the error.

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