Management of Frail and Older Homebound Patients with Heart Failure: A Contemporary Virtual Ambulatory Model

Abstract Background: Heart failure (HF) affects many patients who are older and frail with multiple physical barriers to accessing specialty care in a traditional ambulatory clinic model. Here, we present an assisted virtual care model in which a home visiting nurse facilitated video visits with a HF cardiologist to follow homebound, frail and older patients with HF. Methods: This is a pragmatic quasi-experimental pre-post single-centre study. It included homebound, frail and older patients with HF from 2015-2019 followed for one year where in-person clinic visits were completely replaced by nurse-facilitated virtual video visits. Outcomes evaluated included annualized hospitalization rate, hospitalization days and emergency department (ED) visits. Results: A total of 49 patients were included with a median age of 86 (83-93) years and followed for 1 year after enrollment. Among patients enrolled, HF with preserved ejection fraction was the most common subtype (57%). Compared to the year prior to enrollment, patients had a lower mortality adjusted all-cause annualized hospitalization rate in the year following enrollment (2.57 vs 1.78, p Conclusion: Nurse-assisted virtual visits may be a preferable strategy for homebound, frail and older patients with HF to receive longitudinal care. This approach may represent a plausible strategy to care for other patients with significant barriers to accessing specialized cardiac care.