LAUSR

Introduction Published guidelines recommend that patients being discharged home after hospitalization for HF should be offered a 7 to 14 day post-discharge outpatient clinic visit as a way to increase engagement with care and reduce risk of poor outcomes (ACCF/AHA Class IIa recommendation). At our institution no-show rates for the 7-day post-discharge outpatient visit in this population are as high as 76%, suggesting poor engagement. A reason that patients may not show up for in-person visits may be related to the complexity, inconvenience, or difficulty of getting to the appointment. Virtual visits, secure telemedicine videoconferencing between a clinician and a patient at home using any available consumer device with audiovisual capabilities, are available for use via our institution. We hypothesized that substituting in-person visits with virtual visits may increase patient engagement with medical care therefore reducing no-show rates. Methods Virtual Visits in Heart Failure Care Transitions (VIV-HF) is a randomized clinical trial (ClinicalTrials.gov Identifier: NCT03675828) comparing 7-day post-discharge virtual visits to in-person outpatient clinic visits among patients hospitalized for HF. The primary outcome is appointment no-show rates. The secondary outcomes are a composite and individual components of unscheduled all-cause first occurrence of hospital readmission, emergency department visit, or death, in the first 45 days after hospital discharge. We estimated that the no-show rate in the in-person arm would be 76% based on our historical experience, and 51% in the virtual visit arm. Based on this we estimated that we would need to follow approximately 108 patients to provide the study with a power of 80% to detect a difference of 25% between the study groups, at an overall two-sided alpha level of 0.05. Results As of the date of this submission July 1, 2019, we have enrolled 100 patients (93% of goal). We anticipate finishing recruitment and ascertainment of the primary end-point by mid-August 2019. Conclusions ViV-HF is testing the hypothesis that substituting in-person visits with virtual visits may increase patient engagement with medical care therefore reducing appointment no-show rates. Results will be presented as a late breaking clinical trial at the Heart Failure Society of America Annual Scientific Meeting in Philadelphia, in September 2019.