Telehealth Management and Risk Stratification of Older Patients With Chronic Heart Failure During COVID-19 Pandemic: Prognostic Evaluation of the TeleHFCovid19-Score.
Francesco Orso, Andrea Herbst, Marta Migliorini and 12 others
PMID 35041828WHAT IT FOUND
In 146 older heart failure patients, a phone risk score sorted people into green, yellow, and red groups.
Green patients had significantly fewer cardiovascular deaths or heart failure hospitalizations at 1, 3, and 6 months than yellow or red patients.
Key findings
01A telephone questionnaire assigned 146 older heart failure patients to green (112), yellow (21), or red (13) risk groups.
02At 6 months, 20 patients had died and 32 had been hospitalized; the primary composite outcome rate was 17.8%.
03Patients coded green had a significantly lower incidence of the primary composite outcome than yellow or red patients at 1, 3, and 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No control group was used, so the study cannot show that the score or telephone follow-up changed outcomes compared with usual care. The sample was small and selective: 146 very old patients with a high burden of comorbidities, so results may not apply to younger or less complex heart failure patients. The score was created and weighted by the study authors using clinical judgment and literature review, and its preliminary implementation had been reported in only 30 patients before this study. The study took place during the COVID-19 pandemic, when usual care, access to hospital, and patient behavior may have been different from normal practice. The paper did not test nurse-led use of the score; the suggestion that specialized heart failure nurses could manage low-risk patients was not evaluated.
The easy way to misread this
Do not conclude that the TeleHFCovid19-Score improved outcomes or that nurse-led telephone management is proven. The study had no control group and only observed that patients assigned to the green group later had a lower incidence of cardiovascular death or heart failure hospitalization than patients assigned to the yellow or red groups.