JMIR Publications

ABSTRACT

Background:

Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing significant burden on patients, families, and healthcare systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual healthcare services, delivered by interdisciplinary teams represent a promising solution. Understanding the outcomes and experience of remote monitoring-enabled interdisciplinary chronic disease management programs can inform resource allocation and healthcare policy decisions.

Objective:

The purpose of this study was to evaluate the clinical and behavioral outcomes of patients undertaking a Virtual Home Health Heart Failure Program (VHHHFP) and explore the experiences of patients and health care practitioners.

Methods:

The VHHHFP is a virtual post discharge support service for patients with heart failure that includes an intensive 3-month period followed by a maintenance period delivered by an interdisciplinary team. A mixed methods study was conducted with patients and health practitioners. Self-reported outcome data (KCCQ12, PHQ4, PAM13 and PREMS) were obtained from the records of patients (n=55) who completed the intensive phase of the VHHHFP; and interviews were conducted with patients (n= 9) and health practitioners (n= 6). Paired t- test was used to compare quantitative data before and after the three-month intervention and thematic qualitative analysis undertaken of interview data.

Results:

Thirty-one (77.5%) of the n=55 patients completed the baseline and three-month follow-up KCCQ12 assessment. The mean KCCQ12 Summary Score at three months was 72.20 which was significantly higher than the mean Summary Score at baseline of 50.51 (p<.001). These findings were similar for the KCCCQ12 sub-scales: Physical Limitations (47.09 and 69.43, p<0.001), Quality of Life (43.75 and 62.91, p<0.001), Symptom Frequency (60.40 and 91.70; p<0.001) and Social Limitation (50.0 and 82.50; p<0.001). The PHQ-4 measure of psychological health was completed by n=32 (80%). The median scores at baseline and follow-up for Total Distress (1.50 and 0.0; p<0.02), and the Anxiety sub-scale (1.0 and 0.0; p <0.02) reduced over time. Six hospital admissions were recorded (10.2% of n=49) within 30 days. Nine patient interviews aligned with the Value Based Healthcare (VBHC) Capability Comfort and Calm (CCC) Framework. Three themes were identified 1) Enhanced patient capability, 2) Improved patient comfort and 3) Positive influences on Calm. Six healthcare professionals shared experiences of the VHHHFP, with three emerging themes- 1) Improved patient capability through shared decision making, 2) Improving Capability through care practices and 3) Promoting Comfort and Calm through virtual coordination and collaboration.

Conclusions:

The use of technologies to support the management of HF is an area of growth. This study contributes to the understanding of how remote patient monitoring with interdisciplinary chronic disease support integrated into an existing system can improve clinical outcomes for patients.