(CCSP085) VIRTUAL VISITS EVAULATION IN HEART FUNCTION CLINICS

Background: With the onset of the COVID-19 pandemic, two heart function clinics (HFCs), both based at quaternary-care hospitals, began virtual visits. New protocols and workflows were developed quickly and amended as the pandemic progressed. We report an evaluation of this telemedicine model to determine its effectiveness in achieving target medical therapy, patient satisfaction and costs to patients.

METHODS AND RESULTS: We conducted a quasi-experimental, retrospective, pre-test-post-test design, with historical controls and both quantitative and qualitative measures. We sampled from patients referred between January 2019 and March 2020 (Usual Care (UC)) and between June 2020 and May 2022 (Virtual Care (VC)). We included consecutive patients meeting the inclusion criteria. We collected demographic data, and whether patients reached 50% of the target dose in 3 classes of heart failure goal directed medical therapy (1) angiotensin-converting enzyme inhibitor, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors (together termed AAA) 2) beta-blockers (BB), and 3) mineralocorticoid receptor antagonists (MRA) at referral, 6 months and 12 months. We also invited a subsample of the VC group to complete a patient-satisfaction and costing survey, to understand the impact of VC from the patient’s perspective.

VC patients were younger (66.2 years) versus UC (69.8 years) group, (p= 0.049). A higher proportion of UC patients reached 50% of target in all three drug classes for all time intervals, though not statistically significant. As well, at 12 months, the proportion of VC patients reaching target for MRAs and BB declined, compared to those reaching target at 6 months. Controlling for age, we found the VC group was less likely to reach 50% of target for AAA at 6 months (OR, 0.45; 95% CI: 0.22-0.93), BB at 6 months (OR, 0.32; 95% CI 0.14-0.75) and at 12 months (OR, 0.26; 95% CI: 0.11-0.61), compared to the UC group. For BB at 6 and 12 months, age was also significantly associated with reaching target, with each additional year of age decreasing the likelihood of reaching target by 5%. Analysis of the VC patient satisfaction survey indicated high patient satisfaction and some cost savings.

Conclusion: Although this study was not powered to ascertain non-inferiority, the trends identified should trigger a critical examination of VC. Although VC was implemented based on necessity, evaluation of safety and efficacy is nevertheless essential as we plan for future models of cardiac care.