Virtual Visits or In-Person? The ViV-HF Study

Using a virtual visit format for caregiver appointments in patients recovering from heart failure (HF) who are transitioning to home was associated with a reduction in no-shows.

In a late breaking clinical study presented at the 2019 Heart Failure Society of America Scientific Meeting in Philadelphia, Eiran Gorodeski, MD, MPH, an associate professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and a staff cardiologist at the Cleveland Clinic’s Heart and Vascular Institute, presented the results of the Virtual Visits in Heart Failure Care Transitions (ViV-HF) study, which aimed to quantify the extent to which virtual visits in substitution for in-person clinical appointments with caregivers would improve no-show rates.

The study included patients hospitalized for HF who had been discharged to home. Patients received either virtual visits (n=52) or in-person visits (n=56). The primary study outcome was no-show rates at seven days post-discharge, with clinical outcomes of hospital readmission, emergency department visit, or death.

According to the study results, the primary outcome did not reach statistical significance (RR=0.69; 95% CI, 0.44-1.09; P=0.12). Gorodeski did note that while not statistically significant, there was a more than 30% decrease in the no-show rate. There were no differences between study groups for hospital readmission, ER visits, or death individually.

“We proved the feasibility of substituting in-person visits with virtual visits for patients transitioning from hospital-to-home after hospitalization for HF,” Gorodeski concluded. “ This strategy led to a reduction of no-show rates.”

He went on to note that the reduction “was not statistically significant due to lower than anticipated event rates in the control arm, suggesting that the study was underpowered (a type II error).”

Regarding future directions, a larger trial is warranted, Gorodeski said.

“Our study suggests that a strategy of post-discharge virtual visits in patients hospitalized for HF,” he added. “ This strategy may reduce post-discharge appointment no-show rates. This needs to be studied further in larger appropriately powered clinical trials.”

⁦@EiranGorodeski⁩ presents Late Breaker at #HFSA2019 – the CCF feasibility experience with virtual HF visits, safe and trend reduction of no show rates observed. Look forward to next steps – randomized trial powered to better understand benefits and risks! pic.twitter.com/ytGgi1dyOI

— Jerry Estep (@JerryEstepMD) September 16, 2019

@EiranGorodeski presents VIV-HF study from @ClevelandClinic at #HFSA2019 LBCT packed room showing feasibility & safety of virtual visits after #heartfailure discharge. Excellent discussions in logistics, challenges, and future directions. @CCFcards @lam_mph pic.twitter.com/XSFBxcjy60

— W. H. Wilson Tang, MD (@WilsonTangMD) September 16, 2019

Thank you Jerry for your support and encouragement along the way!! @WilsonTangMD @rcstarling What an honor to stand on the podium in this conference. #grateful

— Eiran Gorodeski, MD, MPH (@EiranGorodeski) September 16, 2019