Structured telephonic support in a heart failure outpatient clinic, from atemporary necessity imposed by COVID to a permanent opportunity for improvement

Background: The disease management of heart failure (HF) provides therapeutic paths with a strong economic burden. The COVID 19 pandemic has forced many clinics, including those dedicated to HF patients, to reshape their activities resorting to care models with limited use of resources, without deterioration of quality. Aims. Feasibility, safety and sustainability of a structured telephone follow-up (STS) as a substitute/supplementary system of outpatient clinical control in patients with HF regularly followed up in a specialist outpatient clinic (HF Clinic). Methods: During the closing period of the HF Clinic all the patients booked were interviewed in place of the standard visit. A standardized telephone interview investigated symptoms, therapeutic/lifestyle compliance, blood chemistry tests, general conditions. Based on the responses, the follow-up was scheduled by a cardiologist according to a priority scale: Priority 1 (check within 1 month) if: first post-discharge check-up or evaluation for device or congestion increasing or ejection fraction decreasing at the previous check-up;Priority 3 (check within 6 months): if periodic visits to device wearers, specific stable cardiomyopathies (such as hypertrophic) or stable valvular diseases;Priority 2 (check within 3 months): all patients not in priority 1 or 3. Results: Between 1/3/20 and 31/5/20, 177 patients were contacted. Mean age 72.6 Median 76 SD 12.9;110 males;NYHA 1.96 SD 0.6;FE 47.5% median 48 SD 10: Etiology: CAD 50, DCM 49, Valvulopathies 32, Other 44;sCr 1.14 mg/dl (range 0.6- 3.4);Therapy: bblockers 83%, iRAAS 56%, ARNI 14%. After the STS, 81 checks were performed at 1 month, 55 at 3 months, 41 at 6 months. In a median follow-up of 199 days (175-235 days) there were: 4 deaths (2%) of which 2 for end-stage HF, 1 for sepsis, 1 before STS for marasmic state, with mean elapsed time STS/exitus 153 days, 25 unscheduled hospital admissions in 16 patients with average elapsed time STS/ first hospitalization 84 days, 4 accesses to the ED in 3 patients, average elapsed time STS/recourse to the ED 130 days. Conclusions: An STS in HF disease management was feasible, low-cost and well- accepted by patients. In our experience, no alarming data regarding safety emerged. Such follow-up systems should be implemented on a permanent basis as part of the HF management programs.