key: cord-0051150-24mjjvij
authors: Vidula, Himabindu; Cheyne, Christina; Martens, John; Gosev, Igor; Zareba, Wojciech; Goldenberg, Ilan
title: Telehealth for the Management of Left Ventricular Assist Device Patients
date: 2020-10-06
journal: J Card Fail
DOI: 10.1016/j.cardfail.2020.10.001
sha: 799644d3cef28993bf20de2d2ad51ef4b801280f
doc_id: 51150
cord_uid: 24mjjvij

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Telehealth visits for cardiac conditions, including heart failure (HF), are increasing 1,2 . However, comprehensive remote evaluation of left ventricular assist device (LVAD) patients poses a challenge since specialized equipment is required, including physical connection to a LVAD monitor to perform a complete interrogation and change LVAD speed and Doppler ultrasound for blood pressure (BP) measurement 3, 4 . To our knowledge, the use of videoconferencing visits for comprehensive management of LVAD patients aimed to replace in-person visits has not been previously studied.

Currently, 238 patients who underwent LVAD implantation at University of Rochester (UR) and live a mean of 62±46 miles (range 1-264) from UR are managed as outpatients. During the first year after index discharge, clinic utilization is high and patients return to UR VAD Clinic a mean of seven times for routine visits and two times for urgent visits.

Prior to the coronavirus-2019 (COVID-19) pandemic, we conducted a prospective singlecenter observational study (TeleLVAD Study) to evaluate the feasibility and safety of comprehensive videoconferencing visits vs. conventional in-person VAD Clinic visits among patients residing in a remote location. We hypothesized that videoconferencing visits are a safe alternative to in-person visits and improve healthcare utilization and quality of life. (Table 1, Supplemental Table) . Medication and LVAD speed changes were conducted remotely at a similar or somewhat higher rate compared to in-person visits. On average, videoconferencing visits were ten minutes shorter than in-person visits. However, a limitation of this study is that physical exam findings during videoconferencing visits were not confirmed by in-person examination on the same day. During 4-week follow-up, one patient was hospitalized for GI bleeding after videoconferencing visit and one patient was hospitalized for medical noncompliance and right HF requiring IV diuresis after both in-person and videoconferencing visits. Patients had a 99% positive response to twelve questions in the TUQ and saved an average 118 minutes of travel time during videoconferencing visits.

The results of this pilot prospective study demonstrate for the first time that videoconferencing visits can be used to complete a comprehensive examination and accomplish management decisions in LVAD patients remotely with high patient satisfaction. Furthermore, we show for the first time that medication management and LVAD speed change can be conducted remotely in LVAD recipients. We believe that these pilot findings have important implications during the current COVID-19 pandemic. Future larger randomized trials are needed to evaluate the long-term safety of remote videoconferencing management and its efficacy in reducing adverse events in the high-risk LVAD population. 

Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America

Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic

Telemonitoring of left-ventricular assist device patients-current status and future challenges

Teleconsultation for left ventricular assist device patients: a new standard of care (letter)