JMIR Publications

ABSTRACT

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, post-consultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc. (HBH), a cardiovascular digital health company, to 11 SNFs (3,510 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 is to assess whether a virtual cardiovascular care program could improve access to specialty care, thereby reducing the 30-day hospital readmission rate for HF patients 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 telemedicine visit via smartphone, tablet, or laptop device for cardiac patients identified by a SNF care team. Post-consult 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 virtual consultation compared to the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3,510 SNF beds. 185 patients (7%) received virtual cardiovascular care via the HBH 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 $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.