This post was developed as part of the Heart Failure Awareness Week 2021 Heart Failure Top Innovations Countdown. 

Submitted by Kismet Rasmusson, DNP, FNP, FAHA, FHFSA, CHFN, Nurse Practitioner, Intermountain Healthcare @KismetRasmu 

Telehealth...Virtual Visits... Remote Monitoring... What Does this Mean for Patients with HF?   

You may be vaguely or very familiar with these terms. But let’s review definitions and what this means for patients with HF.  

In HF care, we’ve been using various forms of telehealth (TH) or televisits for patients for a while now, but given the COVID-19 pandemic, their use has dramatically increased in the response to the need to keep patients with HF safe and cared for. While the pandemic has been awful for so many and in so many ways, the silver lining is that we have needed to use technology and innovation to think differently about how we offer care to patients[1]. By offering visits that keep people safe and away from hospitals and other health care clinics- we are creating a ‘new normal’ in how we can increase access to care during the pandemic and beyond.  

So what do these terms really mean? TH is a broad term that can include anything by a variety of health care practitioners from a phone call to ask about symptoms and provide health information to using more sophisticated devices to help monitor patients.   A virtual visit (VV), also known as a Video Visit, is a specific type of telehealth, it’s essentially a two-way visit using usual consumer devices (phone, tablet or computer) to directly connect a patient to their health care provider real-time (usually with doctor, NP, PA, RN, pharmacist). These visits allow you to see and listen to each other, so they can assess how you are doing and to make a plan of care.    

Advantages of VV: 

• The biggest advantage to patients is that VV are more convenient, they can be done from your own home. This allows less travel, less expense with travel and is relatively easy. 
• Patients with HF who were surveyed were satisfied with remote visits, mostly due to the convenience[2]. Those who preferred in person visits was due to the personal connection with their clinical team.  
• Lessens exposure risk to others during the pandemic. 
• Less “no shows” (not showing up for their clinic appointments) were found when doing VV in patients with HF [3]. 
• The security of your personal health information is ensured when using approved platforms by your healthcare team.  
• Patients may be more likely to have difficult conversations with their clinician because of their general comfort level of the visit happening from their home[1]. 

Challenges with VV:  

• If you don’t have a smart phone, computer or internet access. This require being creative- do you have a family member or friend/neighbor who can help? Can you go to a local library to use their computer, in a private location? There are ideas to consider.  
• Willingness to try this kind of visit, some are not comfortable with using technology in this way. 
• There will be added challenges for patient who are hard of hearing. 
• There are many types of electronic platforms that are used for VV, some are more complicated than others. Connect with your care team if you have troubles with the platform so your visit can be successful.  
• They don’t replace in-person visits. Remember, your team is there trying to keep you safe. You will be able to go see them in person as the pandemic allows, but likely we will all be using a hybrid of in-person and VV in the future.  
• Clinicians miss out on doing a more complete physical examination (listening to heart, lungs and looking for swelling) that they can do in person[2].  
• There may be technical difficulties with some visit, these are improving over time.  

What you can do to prepare for your televisit: 

• Get ready for your VV! Are you planning for a family member to join you? 
• See if you need to download a specific APP to your phone, tablet or computer for the visit. Your team should give you instructions to do so.  
• Be on time, plan to do the visit at home if possible, in a private location, with good lighting and little background noise. 
• Have a list of concerns and/or questions ready to discuss. 
• Have your medications handy to review. 
• Don’t finish the visit without clear instructions and a follow up plan. 

Remote patient monitoring (RPM) is another term that describes how patients can be monitored using technology from home by their care team. Basic RPM includes monitoring weights, blood pressure and heart rate that is communicated back to your care team on a platform that reports trends of your vital signs.  Another way some patients are remotely monitored is through implanted cardiac devices [4]. Information about your heart rhythm and other information is shared electronically from internal cardiovertor-defibrillators (ICDs) or from a combined device cardiac resynchronization therapy with or without a defibrillator (CRT+/- ICD).

A more sophisticated implanted cardiac device is called CardioMEMSTM. This device directly measures pressure in the pulmonary artery, that gives an indication of worsening HF. By following these pressure trends, clinical teams can make medication changes to keep patients stable. This has the added benefit of reducing the need to be hospitalized. All of these devices are implanted in the hospital and then require teams to monitor and interpret the trends in data that may lead to changes in your treatment plan.  

So what’s the future for using technology in patients with HF? This past year has taught us how to think about patient care in a new way, to stay in touch with patients who are not seen in clinic, to assess how they are doing and to continue a plan of care. As technologies continue to be developed, they will help us with our goal – to keep patients safe and well cared for so they may live their healthiest life possible.  

1. Gorodeski, E.Z., et al., Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America. J Card Fail, 2020. 26(6): p. 448-456. 
2. Kerr, B., et al., Changing to remote management of a community heart failure population during COVID-19 - Clinician and patient perspectives'. Int J Cardiol Heart Vasc, 2020. 31: p. 100665. 
3. Gorodeski, E.Z., et al., Virtual Versus In-Person Visits and Appointment No-Show Rates in Heart Failure Care Transitions. Circ Heart Fail, 2020. 13(8): p. e007119. 
4. Lander, M.M., N. Aldweib, and W.T. Abraham, Wireless Hemodynamic Monitoring in Patients with Heart Failure. Curr Heart Fail Rep, 2021. 18(1): p. 12-22.