School of Medicine, University College Dublin, Dublin, Ireland
Cardiology Department, St Vincent's Healthcare Group Dublin, Ireland, Dublin, Ireland.
Open Heart. 2023 Aug;10(2). doi: 10.1136/openhrt-2023-002329.
The heart failure (HF) virtual consultation (VC) is an eHealth tool for delivery of peer-to-peer specialist advice to general practitioners (GPs) to discuss HF diagnosis/management. We aim to investigate the impact of the VC service on onward referral rate and quality of assessment by GPs, as well as assess VC patient characteristics; Clinical Frailty Score (CSF), age and morbidity.
This prospective observational study collected VC data on: demographics, comorbidity, frailty, referral indication, the impact of VC on clinical care and the GP response to the question 'what would you have done without the VC service'. We compared patient characteristics to a control population of patients attending the HF unit (HFU) (n=118).
Between 2015 and 2021, 1681 VC cases were discussed. The majority of cases were discussed from remote areas (75%). Rediscussion cases increased from 0% to 34%. VC patients were older (76.2 (±11.3) vs 73.1 (±12.5) years, p<0.05), more frail (CSF=3.8 (±1.7) vs 3 (±1.6), p<0.01) and multimorbid (number of comorbidities=7.1 (±3.4) vs 3.8 (±1.9), p<0.001) compared with patients attending the HFU. Without the VC, 93% of cases would have been referred to face-to-face hospital services. Instead, VC resulted in only 9% of cases being referred to hospital services. The remainder of cases were managed by the VC service, in a shared GP-specialist approach. GP use of natriuretic peptide (NP) increased from 0% in 2015-2016 to 63% in 2021 and use of TTE increased from 0% in 2015-2016 to 69% by 2021.
The VC service provides a platform for case discussion in particular for older, frailer patients and reduces onward hospital referrals. This may facilitate early diagnosis and management of suspected HF in the current era of long outpatient waiting times. The quality of community HF assessment improved as indicated by increased use of NP/TTE by GPs.
心力衰竭（HF）虚拟咨询（VC）是一种电子健康工具，用于向全科医生（GP）提供同行专家建议，以讨论 HF 的诊断/管理。我们旨在研究 VC 服务对 GP 转诊率和评估质量的影响，以及评估 VC 患者的特征；临床虚弱评分（CSF）、年龄和发病情况。
这项前瞻性观察性研究收集了 VC 数据：人口统计学、合并症、虚弱、转诊指征、VC 对临床护理的影响以及 GP 对“如果没有 VC 服务，您会怎么做”这个问题的反应。我们将患者特征与在 HF 病房（HFU）就诊的对照组患者（n=118）进行了比较。
在 2015 年至 2021 年间，共讨论了 1681 例 VC 病例。大多数病例来自偏远地区（75%）。重新讨论的病例从 0%增加到 34%。VC 患者年龄更大（76.2（±11.3）岁比 73.1（±12.5）岁，p<0.05），更虚弱（CSF=3.8（±1.7）比 3（±1.6），p<0.01），合并症更多（合并症数量=7.1（±3.4）比 3.8（±1.9），p<0.001）。与 HFU 就诊的患者相比。如果没有 VC，93%的病例将被转诊至面对面的医院服务。相反，VC 仅导致 9%的病例被转诊至医院服务。其余病例由 VC 服务管理，采用 GP-专家共同管理的方式。GP 对利钠肽（NP）的使用从 2015-2016 年的 0%增加到 2021 年的 63%，对经胸超声心动图（TTE）的使用从 2015-2016 年的 0%增加到 2021 年的 69%。
VC 服务为病例讨论提供了一个平台，特别是对于年龄较大、身体更虚弱的患者，并减少了后续的医院转诊。这可能有助于在当前门诊等待时间较长的情况下，尽早诊断和管理疑似 HF。随着 GP 对 NP/TTE 的使用增加，社区 HF 评估质量有所提高。
