Decongest the Clinic—a Compulsory Experiment with Virtual Heart Failure Care In the Bronx

INTRODUCTION: At the epicenter of the COVID-19 pandemic, there was an urgent need to limit the exposure of patients (pts) to SARS-CoV-2. This required shuttering high risk areas which included outpatient offices; however, the ongoing acuity of heart failure (HF) pts concurrently mandated close follow up. To overcome this predicament, at our institution pts were asked to stay at home and engage in virtual HF visits (VHFVs) via telephone or video, in lieu of in-office visits (IOVs). The purpose of this abstract is to summarize and assess the feasibility of our initial 30 day experience with VHFVs. METHODS: The Montefiore- Einstein Heart Failure service cares for over 4,000 pts who predominantly reside within the Bronx borough, and represent a vulnerable, urban, low socioeconomic population. Our team includes 12 providers consisting of both NPs and MDs. On 3/17/20 all non-urgent IOVs were stopped and as a work around a virtual platform was created within our electronic medical record system (EPIC) to facilitate VHFVs. As of April 1(st), all IOVs were converted to VHFVs. We retrospectively reviewed the HF clinical volume for the month of April 2020 and as a reference compared it to the same time period in 2019. In addition, we followed high risk pts (defined as those requiring multiple visits during the month for acute decompensated HF [ADHF] or renal failure) for clinical outcomes including hospital admission. RESULTS: Over the 30 day period from April 1-30(th) 2020, 510 HF pts had a total of 605 VHFVs and 17 IOVs. Seventy-five pts required ≥2 visits during this time period of which 26 pts (5%) were categorized as high risk as defined above. Providers reported that 7 (27%) of these pts would have been electively hospitalized under normal circumstances. In the 30 days following initial VHFV, 3 (12%) were urgently hospitalized, 2 of whom would have been electively admitted by provider as above, and none died. Interestingly, clinical volume and outcomes of high risk individuals was comparable in April 2019 (Table 1). Three of 12 (25%) patients with ADHF or renal failure were urgently hospitalized in the 30 day follow up period. At the time of this presentation we intend to report 90 day outcomes on all pts. CONCLUSION: In this preliminary analysis of an experiment that was brought on by the COVID-19 epidemic, VHFVs were not associated with substantially worse clinical outcomes over the short term. Table 1: Comparison of Visit Volumes - April 2019 vs 2020