P250 PROTOCOL FOR TELEHEALTH EVALUATION AND FOLLOW–UP OF PATIENTS WITH CHRONIC HEART FAILURE DURING THE COVID–19 PANDEMIC

Abstract

Background: Because of Coronavirus Disease 2019 (COVID‐19) pandemic, on March 9, 2020 the Italian government imposed a total lockdown and social isolation. After this decision, physicians were forced to review their outpatient activity, limiting ambulatory visits to exceptional cases to reduce interpersonal contact, especially in elderly and frail patients. Although randomized clinical trial present conflicting data about telemedicine in heart failure (HF), also driven by international society, we tried to structur a standardized telephone follow‐up (FU) to nearly 150 patients followed in our HF outpatient clinic. Purpose: To structure a telephone FU, with a standardized 23 item questionnaire from whom we obtained the Covid‐19‐HFscore. Methods: In accordance with current Italian privacy laws, the questionnaire was anonymised, and patients were identified by a numeric code, date of birth and gender. The questionnaire was designed for rapid administration during telephone interview, with a median call duration of 6 minutes, and was administered directly by physicians to patients and/or to their caregiver. It was built to reproduce our usual clinical evaluation. Results: As shown in figure 1, it was designed to investigate seven domains: 1) social and functional condition; 2) mood; 3) adherence to pharmacological and non‐pharmacological recommendations (blood pressure, heart rate, weight monitoring and fluid intake control); 4) clinical and hemodynamic status; 5) recording of laboratory tests; 6) current pharmacological treatment; 7) recent evaluation by family physician or need to contact emergency services followed or not by hospitalisation, and reasons for these medical contacts. General and pharmacological recommendations as well as the following telephone contact were finally recorded. To determine the timing of the next telephonic evaluation, we decided to weight questions regarding clinical and hemodynamic status, adherence to pharmacological and non‐pharmacological recommendations, therapeutic changes and need for hospitalisation by scoring the answers (from 1 to 3) to build a score. The sum of individual scores represented the novel TeleHFCovid19‐score, ranging from 0 to 29. Based on such score, three groups of patients were identified by arbitrary cut‐off levels: the green (score <4), the yellow (score 4‐8) and the red (score ≥9) group, for which next telephonic evaluation was planned respectively after four, two and one week respectively. Alternatively, the red group could receive recommendation for urgent hospital evaluation. Conclusion: During this emergency situation this questionnaire could be a useful clinical tool to help physicians maintaining a regular FU of their patients and identifying patients at greatest risk of imminent instability, who may need urgent clinical evaluation. Furthermore, at the end of the pandemic, this instrument could also represent a useful resource in the management of low‐risk HF patients.