Telehealth Management and Risk Stratification of Older Patients With Chronic Heart Failure During COVID-19 Pandemic: Prognostic Evaluation of the TeleHFCovid19-Score

Abstract

Objectives: To evaluate 6-month risk stratification capacity of the newly developed TeleHFCovid19-Score for remote management of older patients with heart failure (HF) during the coronavirus disease 2019 pandemic.

Design: Monocentric observational prospective study.

Setting and participants: Older HF outpatients remotely managed during the first pandemic wave.

Methods: The TeleHFCovid19-Score (0-29) was obtained by an ad hoc developed multiparametric standardized questionnaire administered during telephone visits to older HF patients (and/or caregivers) followed at our HF clinic. Questions were weighed on the basis of clinical judgment and review of current HF literature. According to the score, patients were divided in progressively increasing risk groups: green (0-3), yellow (4-8), and red (≥9).

Results: A total of 146 patients composed our study population: at baseline, 112, 21, and 13 were classified as green, yellow, and red, respectively. Mean age was 81±9 years, and women were 40%. Compared to patients of red and yellow groups, those in the green group had a lower use of high-dose loop diuretics (P < .001) or thiazide-like diuretics (P = .027) and had reported less frequently dyspnea at rest or for basic activities, new or worsening extremity edema, or weight increase (all P < .001). At 6 months, compared with red (62.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization (P < .001). Moreover, receiver operating characteristic curve analysis showed a high sensibility and specificity of our score at 6 months (area under the curve = 0.789, 95% CI 0.682-0.896, P < .001) with a score <4.5 (very close to green group cutoff) that identified lower-risk subjects.

Conclusions and implications: The TeleHFCovid19-Score was able to correctly identify patients with midterm favorable outcome. Therefore, our questionnaire might be used to identify low-risk chronic HF patients who could be temporarily managed remotely, allowing to devote more efforts to the care of higher-risk patients who need closer and on-site clinical evaluations.

Keywords: COVID-19; Heart failure; SARS-CoV-2; pandemic; telehealth; telemedicine.

Fig. 1

COVID-19 HF outpatient follow-up questionnaire. ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; GDMTs, guideline-directed medical treatments; MRA, mineralocorticoid receptor antagonist; RI, respiratory insufficiency; SBP, systolic blood pressure; SNB, sequential nephron blockade; WRF, Worsening Renal Function.

Fig. 2

Comparison of primary and secondary outcomes in study population. In panels A, B, and C, a comparison of primary (CV death and/or HF hospitalization) and secondary (CV death and HF hospitalization singularly) outcomes between the 3 color groups is respectively shown with the trend at 1, 3, and 6 months.

Fig. 3

ROC curve analysis of TeleHFCovid19-Score. TeleHFCovid19-Score showed a good diagnostic power with a wide AUC, demonstrating a high capacity of predicting primary outcome at the short and medium term. Patients with the lowest risk of primary outcome were those with a score <4.5 at all 3 follow-up intervals. AUC, area under the curve; ROC, receiver operating characteristic.