Telemedicine in management of heart failure: experience of the south-east Tuscany in COVID-19 period

BACKGROUND: The lockdown imposed by the COVID-19 pandemic has prompted the implementation of the use of Telemedicine (TL), overcoming the assumption of a service: the simultaneous on-site presence of the producer and user of that service. We aimed to evaluate the impact of TL on the management of the out-patient (MOP) with heart failure in both clinical and economic terms. METHODS: A prospective randomized trial of heart failure patients was performed at the Medical Area Cardiology of Cortona Hospital, Tuscany. From May to September 2020, 300 patients were enrolled and followed for 9 months. They were equally and randomly assigned to the MOP group with the possibility of ordinary hospitalization or to the TL group and followed through home care. The groups were homogeneous in terms of gender, age, comorbidities, presence or absence of caregivers, ability to connect to internet, and provision of the necessary tools to monitor their condition. RESULTS: 48% of the services provided were TL (Televisit and Teleconsultation) while the remaining 52% were MOP services. There is no significant difference in terms of care delivered. In TL, per service, 0.09h were spent while in MOP 0.26h (also considering the application of anti-COVID procedures). In addition to savings in space, staffing and technology used, there was also a significant reduction in costs with TL (e.g., € 1600.00 per day of ICU admission, € 850.00 per day of ordinary hospitalization, € 150.00 per Emergency Department access). CONCLUSIONS: TL has achieved economic savings, appropriateness of care with increased equity, effectiveness, and efficiency (due to continuous patient monitoring) resulting in reduced hospitalization. However, this requires an initial investment in resources as well as good integration between Hospital and Territory. KEY MESSAGES: • Telemedicine has reduced costs, time per visit, and resources in general. It constitutes an advantage for monitoring chronic patients. • To make the best use of telemedicine, a good network between hospital and territory is needed.