Heart failure virtual consultation: caters for frailer, multimorbid and remote patients
Background: The heart failure (HF) virtual consultation (VC) is an eHealth tool for delivery of peer-to-peer specialist advice to general practitioners (GPs) to discuss HF diagnosis/management. We aim to investigate the impact of the VC service on onward referral rate and quality of assessment by GP...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/2/e002329.full |
| _version_ | 1797366777849577472 |
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| author | Mark Ledwidge Matthew Barrett Bethany Wong Joseph McCambridge Lisa McCudden Ronan Fawsitt Joseph J Gallagher Kenneth McDonald |
| author_facet | Mark Ledwidge Matthew Barrett Bethany Wong Joseph McCambridge Lisa McCudden Ronan Fawsitt Joseph J Gallagher Kenneth McDonald |
| author_sort | Mark Ledwidge |
| collection | DOAJ |
| description | Background: The heart failure (HF) virtual consultation (VC) is an eHealth tool for delivery of peer-to-peer specialist advice to general practitioners (GPs) to discuss HF diagnosis/management. We aim to investigate the impact of the VC service on onward referral rate and quality of assessment by GPs, as well as assess VC patient characteristics; Clinical Frailty Score (CSF), age and morbidity.Methods: This prospective observational study collected VC data on: demographics, comorbidity, frailty, referral indication, the impact of VC on clinical care and the GP response to the question ‘what would you have done without the VC service’. We compared patient characteristics to a control population of patients attending the HF unit (HFU) (n=118).Reults: Between 2015 and 2021, 1681 VC cases were discussed. The majority of cases were discussed from remote areas (75%). Rediscussion cases increased from 0% to 34%. VC patients were older (76.2 (±11.3) vs 73.1 (±12.5) years, p<0.05), more frail (CSF=3.8 (±1.7) vs 3 (±1.6), p<0.01) and multimorbid (number of comorbidities=7.1 (±3.4) vs 3.8 (±1.9), p<0.001) compared with patients attending the HFU. Without the VC, 93% of cases would have been referred to face-to-face hospital services. Instead, VC resulted in only 9% of cases being referred to hospital services. The remainder of cases were managed by the VC service, in a shared GP-specialist approach. GP use of natriuretic peptide (NP) increased from 0% in 2015–2016 to 63% in 2021 and use of TTE increased from 0% in 2015–2016 to 69% by 2021.Conclusions: The VC service provides a platform for case discussion in particular for older, frailer patients and reduces onward hospital referrals. This may facilitate early diagnosis and management of suspected HF in the current era of long outpatient waiting times. The quality of community HF assessment improved as indicated by increased use of NP/TTE by GPs. |
| first_indexed | 2024-03-08T17:09:29Z |
| format | Article |
| id | doaj.art-17fea88f9dbc4a95a89bf5cf1483c300 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-08T17:09:29Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-17fea88f9dbc4a95a89bf5cf1483c3002024-01-04T00:05:09ZengBMJ Publishing GroupOpen Heart2053-36242023-11-0110210.1136/openhrt-2023-002329Heart failure virtual consultation: caters for frailer, multimorbid and remote patientsMark Ledwidge0Matthew Barrett1Bethany Wong2Joseph McCambridge3Lisa McCudden4Ronan Fawsitt5Joseph J Gallagher6Kenneth McDonald7School of Medicine, University College Dublin, Dublin, IrelandCardiology Department, St Vincent’s Healthcare Group Dublin, Ireland, Dublin, IrelandSchool of Medicine, University College Dublin, Dublin, IrelandCardiology Department, St Vincent’s Healthcare Group Dublin, Ireland, Dublin, IrelandCardiology Department, St Vincent’s Healthcare Group Dublin, Ireland, Dublin, IrelandThe Surgery Castle Gardens, Kilkenny, IrelandChronic Cardiovascular Disease Unit, St Vincent’s University Hospital, Dublin, IrelandSchool of Medicine, University College Dublin, Dublin, IrelandBackground: The heart failure (HF) virtual consultation (VC) is an eHealth tool for delivery of peer-to-peer specialist advice to general practitioners (GPs) to discuss HF diagnosis/management. We aim to investigate the impact of the VC service on onward referral rate and quality of assessment by GPs, as well as assess VC patient characteristics; Clinical Frailty Score (CSF), age and morbidity.Methods: This prospective observational study collected VC data on: demographics, comorbidity, frailty, referral indication, the impact of VC on clinical care and the GP response to the question ‘what would you have done without the VC service’. We compared patient characteristics to a control population of patients attending the HF unit (HFU) (n=118).Reults: Between 2015 and 2021, 1681 VC cases were discussed. The majority of cases were discussed from remote areas (75%). Rediscussion cases increased from 0% to 34%. VC patients were older (76.2 (±11.3) vs 73.1 (±12.5) years, p<0.05), more frail (CSF=3.8 (±1.7) vs 3 (±1.6), p<0.01) and multimorbid (number of comorbidities=7.1 (±3.4) vs 3.8 (±1.9), p<0.001) compared with patients attending the HFU. Without the VC, 93% of cases would have been referred to face-to-face hospital services. Instead, VC resulted in only 9% of cases being referred to hospital services. The remainder of cases were managed by the VC service, in a shared GP-specialist approach. GP use of natriuretic peptide (NP) increased from 0% in 2015–2016 to 63% in 2021 and use of TTE increased from 0% in 2015–2016 to 69% by 2021.Conclusions: The VC service provides a platform for case discussion in particular for older, frailer patients and reduces onward hospital referrals. This may facilitate early diagnosis and management of suspected HF in the current era of long outpatient waiting times. The quality of community HF assessment improved as indicated by increased use of NP/TTE by GPs.https://openheart.bmj.com/content/10/2/e002329.full |
| spellingShingle | Mark Ledwidge Matthew Barrett Bethany Wong Joseph McCambridge Lisa McCudden Ronan Fawsitt Joseph J Gallagher Kenneth McDonald Heart failure virtual consultation: caters for frailer, multimorbid and remote patients Open Heart |
| title | Heart failure virtual consultation: caters for frailer, multimorbid and remote patients |
| title_full | Heart failure virtual consultation: caters for frailer, multimorbid and remote patients |
| title_fullStr | Heart failure virtual consultation: caters for frailer, multimorbid and remote patients |
| title_full_unstemmed | Heart failure virtual consultation: caters for frailer, multimorbid and remote patients |
| title_short | Heart failure virtual consultation: caters for frailer, multimorbid and remote patients |
| title_sort | heart failure virtual consultation caters for frailer multimorbid and remote patients |
| url | https://openheart.bmj.com/content/10/2/e002329.full |
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