Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community ‐ A mixed‐methods evaluation

Abstract

AimsWe undertook a mixed‐methods evaluation of a Web‐based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs.Methods and resultsAll cases from June 2015 to October 2016 were recorded using a standardized recording template, which recorded patient demographics, medical history, medications, and outcome of the virtual consult for each case. Quantitative surveys and qualitative interviewing of 17 participating GPs were also undertaken. During this time, 142 cases were discussed—68 relating to a new diagnosis of heart failure, 53 relating to emerging deterioration in a known heart failure patient, and 21 relating to therapeutic issues. Only 17% required review in outpatient department following the virtual consultation. GPs reported increased confidence in heart failure management, a broadening of their knowledge base, and a perception of overall better patient outcomes.ConclusionsThese data from an initial experience with Heart Failure Virtual Consultation present a very positive impact of this strategy on the provision of heart failure care in the community and acceptability to users. Further research on the implementation and expansion of this strategy is warranted.

Developing a disease management program for the improvement of heart failure outcomes: the do’s and the don’ts

“…A further benefit of this review would be to reinforce self-care education and other allied health care matters. Furthermore, this aspect of the DMP service does not necessarily require direct patient contact with the service, but could be achieved by remote review using modern technology [30].…”

“…There are many ways that this can be achieved, including the standard education structures. In addition to standard approaches we have recently developed the virtual consultation model to provide on-line case management advice to the GP without the need for the patient to travel [30] .…”

Motivational interviewing can support physical activity in elderly patients with diastolic heart failure: results from a pilot study

“…12,13 However, there are few effective treatment options for patients with HFpEF, especially in outpatient settings, often lacking improvements in patients' quality of life. 17 The heart failure: a controlled trial investigating outcomes of exercise training (HF-ACTION) trial showed that exercise training (ET) for patients with HFrEF resulted in a decrease of morbidity and rehospitalizations, 18 and in the Ex-DHF pilot trial, ET for patients with HFpEF improved patients' symptoms, exercise capacity, diastolic function, and quality of life. 17 The heart failure: a controlled trial investigating outcomes of exercise training (HF-ACTION) trial showed that exercise training (ET) for patients with HFrEF resulted in a decrease of morbidity and rehospitalizations, 18 and in the Ex-DHF pilot trial, ET for patients with HFpEF improved patients' symptoms, exercise capacity, diastolic function, and quality of life.…”

“…[14][15][16] This gap of care may also stem from a lack of communication skills among treating physicians and other medical professionals, resulting in suboptimal management of the disease, including patient self-care. 17 The heart failure: a controlled trial investigating outcomes of exercise training (HF-ACTION) trial showed that exercise training (ET) for patients with HFrEF resulted in a decrease of morbidity and rehospitalizations, 18 and in the Ex-DHF pilot trial, ET for patients with HFpEF improved patients' symptoms, exercise capacity, diastolic function, and quality of life. 19 Thus, ET appears to be an effective component in the treatment of both HFrEF and HFpEF, and the European Society of Cardiology recommends ET for HF patients, regardless of their EF.…”

Natriuretic Peptide-based Screening and Prevention of Heart Failure

“…The emergence of this strategy of NP screening and targeted intervention requires further study of a number of factors, such as: determining optimal levels of NPs for risk stratification, determining the role of other biomarkers (troponin, ST2 and galectin-3 or multiplex panels in refining risk prediction), the development of clinical prediction rules integrating clinical features and biomarkers to improve risk prediction, the evaluation of alternative systems of care using this approach (increasing the role of generalist physicians or using alternative systems to obtain specialist advice, such as web conferencing), 16 determining the optimal use of medications (RAAS inhibitors and beta-blockers) and refining the need for cardiac imaging in this cohort.…”