Review of Telehealth Solutions for Outpatient Heart Failure Care in a Veterans Health Affairs Hospital in the COVID-19 Era

Read about the Veterans Health Administration's early adoption of telehealth for outpatient heart failure care.
November 2, 2020

Authors: Reema O. Qureshi, MD; Aravind Kokkirala, MD; Wen-Chih WUu MD, MPH

Introduction: Telemedicine encompasses methods to deliver care using medical devices to collect and transmit health information and has become a key medium to deliver healthcare in the COVID-19 pandemic. The Veterans Health Administration (VA) was an early adapter of telehealth services starting in 2003.

Prior to the pandemic, the VA had already established the nation's largest telehealth system. The VA reports over 900,000 veterans used VA telehealth services in 2019 encompassing 2.29 million episodes of telehealth care. The VA hospital employs a multidisciplinary chronic care model for Outpatient Heart Failure management. Important elements of this model include:

1.) Transition of Care consultation for transition between hospital and home.

2.) IV Diuretic Clinic to provide volume assessment and aggressive diuresis as indicated.

3.) Shared Medical Visits to provide self-management education and pharmacologic treatment for heart failure by a multi-disciplinary team.

4.) Heart Failure Clinics to provide close follow-up to veterans at risk for re-hospitalization.

5.) Telemonitoring of weight and vital signs for patients at high risk of decompensation.

The VA has established several formats for administering care via telecardiology that are now being used increasingly under Centers for Disease Control (CDC) guidance to limit community exposure to SARS-CoV-2. We provide an example of telecardiology using heart failure management at a VA Hospital in New England.

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