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

摘要

Telemedicine encompasses methods to deliver care usingmedical devices to collect and transmit health informationand has become a key medium to deliver healthcare in theCOVID-19 pandemic. The Veterans Health Administration(VA) was an early adapter of telehealth services startingin 2003.1 Prior to the pandemic, the VA had already establishedthe nation’s largest telehealth system. The VA reportsover 900,000 veterans used VA telehealth services in 2019encompassing 2.29 million episodes of telehealth care.2The VA hospital employs a multidisciplinary chronic caremodel for Outpatient Heart Failure management. Importantelements of this model include: 1.) Transition of Care consultationfor transition between hospital and home, 2.) IVDiuretic Clinic to provide volume assessment and aggressivediuresis as indicated 3.) Shared Medical Visits to provideself-management education and pharmacologic treatmentfor heart failure by a multi-disciplinary team, 4.) Heart FailureClinics to provide close follow-up to veterans at risk forre-hospitalization, 5.) Telemonitoring of weight and vitalsigns for patients at high risk of decompensation.The VA has established several formats for administeringcare via telecardiology that are now being used increasinglyunder Centers for Disease Control (CDC) guidance to limitcommunity exposure to SARS-CoV-2. We provide an exampleof telecardiology using heart failure management at aVA Hospital in New England.