Predictors of outcomes in patients hospitalised with COVID-19 pneumonitis

Introduction/Aim: Medium and long-term impacts of COVID-19 pneumonitis are being increasingly recognised. Our study aimed to evaluate outcomes of hospitalised COVID-19 patients with moderate-to-severe respiratory compromise. Method(s): Patients admitted to a tertiary centre with COVID-19 pneumonitis (March 2020-October 2022) were followed in the Post-COVID Respiratory Clinic at 6-24 weeks. Baseline demographics, admission details, pulmonary function tests (PFTs), and clinic data were collected. Univariable and multivariable logistic regression were performed to investigate for predictors of persisting respiratory symptoms (dyspnoea, cough, chest pain) and functional limitation (self-reported). Result(s): 125 patients (64.8%male, 63.2+/-16.7years, 42.5% former/current smokers, BMI 31.0+/-8.0kg/m2, 49.6% fully vaccinated) with median follow-up time of 85 [interquartile range (IQR) 64-131] days were included. Pre-existing conditions included lung disease (29.6%), immunocompromise (15.2%), diabetes (24.8%) and hypertension (43.6%). 35.2% required ICU care (14.4% mechanical ventilated, 4% ECMO), 44.8% received high flow nasal prong oxygen and/or continuous positive airway pressure (CPAP). At initial clinic follow up, 65.4% had persisting X-ray changes. Mean predicted FEV1, FVC, DLCO were 86.8+/-20.7%, 85.3+/-20.3%, 82.2+/-19.8% respectively. Symptoms included dyspnoea (63.2%), fatigue (24.2%), cognitive dysfunction (12.9%) and musculoskeletal complaints (10.5%). Univariate predictors of continued respiratory and/or functional disability included age [odds ratio (OR) 1.03, 95%confidence interval (CI) 1.01-1.06, p = 0.01), prior lung disease (OR2.98, 95%CI 1.05-8.48, p = 0.04), hypertension OR2.61, 95%CI 1.09-6.22, p = 0.03) and length of hospital stay (LOHS) (OR1.03, 95%CI 1.00-1.07, p = 0.04). On multivariable analysis, only LOHS was independently predictive of continued respiratory and functional limitations (OR1.03, 95%CI 1.00-1.07, p = 0.02). Conclusion(s): Patients recovering from COVID-19 pneumonitis have a large burden of disability at follow-up. Older age, hypertension, lung disease and LOHS are risk factors for delayed recovery.

The healthcare experiences of patients with COPD: An IPA study

Introduction/Aim: Studies of the lived experience of Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings. The study investigated primary care experiences of patients living independently in the community with doctor diagnosed COPD, who smoke or had recently quit smoking and focused on how vulnerability, stigma and emotional components of care shape care experiences. Method(s): An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom TM and explored healthcare experiences, smoking, stigma and impact of care during COVID-19. Cross-case analysis was conducted to form group experiential themes. Result(s): Participants were aged between 45 to 75 years. Nine were female and two-thirds were current daily smokers. Both positive and negative experiences were explored. Problematic experiences including time-constrained consultations ('You're a number, and that's where I feel like a sheep and [that] can stress you out more'), having to self-advocate for care, and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust ('I have an actual great trust for my GP. they're awesome, they'll look after you'). Conclusion(s): Pro-active, empathetic care from GPs is desired by patients living with COPD who continue to smoke but this is not always reflected in the lived experience of care. Stigma and fear of judgement were important underlying drivers of negative care experiences and need to be carefully considered in provision of care for this group.

Implementing telehealth-delivered group-based education and exercise for osteoarthritis during the COVID-19 pandemic: A mixed-methods evaluation

Introduction: The Good Life with osteoArthritis from Denmark (GLA:D) program provides group-based education (2 sessions) and exercise-therapy (12 sessions) for people with knee and hip osteoarthritis at >500 sites in Australia and is associated with clinically meaningful improvements in pain and quality of life (QoL). During the COVID-19 pandemic, physiotherapists in Australia were supported to provide GLA:D via telehealth. The aim of this mixed-methods project was to evaluate the implementation of GLA:D via telehealth. Method(s):Evaluation Framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST). Quantitative: People with knee or hip osteoarthritis participating in GLA:D via telehealth-only or a hybrid delivery of in-person and telehealth (>=3 telehealth sessions) from March 2020-October 2021. Mean differences (MD) and effect sizes (ES) from baseline to 3-month follow-up were calculated for average pain (0-100) and joint-related QoL (KOOS-QOL, HOOS-QOL sub-scales). Participants rated perceived recovery (global rating of change scale -3 to 3;1-3=recovered) and program satisfaction (scale 1-5;4,5=satisfied).Qualitative: 23 GLA:D trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings completed one-on-one semi-structured interviews. Interviews were transcribed and analysed using a reflexive thematic approach. Results :Reach: 138 people (39 telehealth-only and 99 hybrid delivery;69% female) participated in GLA:D via telehealth.. Mean (SD) age and BMI were 64 (9) years and 29.8 (5.5) kg/m2, respectively. Identified barriers and enablers for reach included technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions to in-person GLA:D was an enabler. Effectiveness: Average pain decreased for telehealth-only (MD, 95%CI=-10, -16 to -4;ES=-0.54) and hybrid delivery (MD=-11, -16 to -6;ES=-0.43) GLA:D. Joint-related QoL improved for telehealth-only (MD=9, 3 to 14;ES=0.51) and hybrid delivery (MD=12, 8 to 16;ES=0.65) GLA:D. At 3-months, 81% of participants were recovered and 88% were satisfied. Most physiotherapists believed telehealth was as effective as in-person and felt patients were better able to continue exercising at home. Adoption: 92 physiotherapists (74 health services) delivered GLA:D via telehealth, most stating it had become a normal part of their practice. Adoption barriers included preferring, and greater confidence with providing, in-person GLA:D. Implementation: 70% (n=96) of participants attended both education sessions and 91% (n=125) attended >10 exercise-therapy sessions. Telehealth-delivered GLA:D involved modifications to assessment, exercise instruction, equipment, and reduced fee structures. Maintenance: Lack of personnel capacity, low patient demand, and a need for telehealth training and support were sustainability barriers. Discussion(s): Telehealth-delivered GLA:D in Australia during the pandemic predominantly involved hybrid delivery. Patient outcomes following telehealth-delivered GLA:D were comparable to published in-person registry data. However, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. Impact and application to the field * Telehealth-delivered group-based education and exercise provides a viable and effective option to provide people with osteoarthritis appropriate first-line care in Australia. * Findings highlight the need for, and can help guide, community education about the value of telehealth, alongside training to support physiotherapists delivering GLA:D via telehealth. My co-authors and I have no conflict of interest related to the submission of this Copyright © 2022

Telehealth-delivered group-based education and exercise-therapy for knee osteoarthritis: A randomised clinical trial interrupted by the COVID-19 pandemic

Introduction: Guidelines recommend education and exercise-therapy as first-line treatments for knee osteoarthritis. The Good Life with osteoArthritis from Denmark (GLA:D) program provides physiotherapist-led group-based education and exercise-therapy at >500 sites in Australia. It is associated with clinically meaningful improvements in pain and quality of life (QoL). However, inability to attend in-person sessions due to geography, transportation requirements, or other commitments limits access. Telehealth (videoconferencing) may improve the equity of access to GLA:D. One-on-one telehealth services for knee musculoskeletal pain conditions including osteoarthritis are reported to be non-inferior to in-person care, but there is a lack of research evaluating group-based telehealth services. This randomised clinical trial (RCT) aimed to determine if GLAD delivered via telehealth was non-inferior to in-person delivery for knee-related burden at 3- (primary timepoint) and 12-months. Method(s): This pre-registered (ACTRN12619000235101) two-arm (telehealth, in-person), non-inferiority RCT commenced in April 2019. Knee osteoarthritis clinical diagnosis was based on NICE guidelines. Difference between groups for change in knee-related burden (primary outcome) was evaluated by averaging four Knee injury and Osteoarthritis Outcome Score subscales (KOOS4: pain, symptoms, function in daily living, QoL), measured at 3- and 12-months follow-up. The KOOS-QoL subscale was evaluated to relate findings to GLA:D Australia registry data. Planned sample size (n=88) was powered at 90% to detect a minimal important difference between groups of 10 (SD=16) points for KOOS4. Result(s): Forty-four participants enrolled at baseline (22 per group), with no difference between telehealth and in-person groups for sex distribution (female/male: 14/8 v 12:10), age (years: 62+/-8 v 64+/-10), or body mass index (kg/m2: 29.8+/-5.3 v 31.1+/-5.2). Recruitment ceased in March 2020 due to COVID-19 restrictions on in-person healthcare. Forty-three (98%) and 40 (91%) participants provided 3- and 12-month follow-up data respectively. Primary Outcome: There were no between group differences for changes in KOOS4, with outcomes favouring telehealth at 3-months (mean difference, 95%CI = 6, -2 to 15), and neither group at 12-months (0, -9 to 9). The lower limit of the 95%CI was within the non-inferiority margin (i.e. -10 points) at both time points. Secondary outcome: Changes in KOOS-QoL at 3- and 12-months for telehealth (18 and 14 points) and in-person (10 and 15) were comparable to published GLA:D registry data (13 and 16). Discussion(s): This RCT was underpowered due to COVID-19 pandemic restrictions causing early cessation, but findings do indicate telehealth-delivered GLA:D is unlikely to be inferior to in-person delivery for knee-related burden at 3- and 12-months. This finding builds on recently published qualitative findings indicating patient acceptability of telehealth-delivered GLA:D and positive telehealth outcomes from the GLA:D registry during the pandemic (submitted to SMA 2022: Ezzat et al). Further supporting implementation, findings are also consistent with published non-inferiority trials of one-on-one telehealth services for knee osteoarthritis and other musculoskeletal pain conditions, and KOOS-QoL outcomes in both groups were consistent with published GLA:D registry data. Implications and application to the field * Telehealth-delivered group-based education and exercise-therapy for knee osteoarthritis appears unlikely to be inferior to in-person delivery. * Physiotherapists should be supported to implement telehealth-delivered GLA:D in Australia. Conflict of interest: A/Profs Barton and Kemp lead the 'not-for-profit' implementation initiative, GLA:D Australia, which trains Australian physiotherapists to implement guideline-recommended education and exercise-therapy. Copyright © 2022

Can Practice-Based Research Networks foster integrated care across the healthcare system? A scoping review

Background: Integrated health care, particularly between the broader health care system and primary care can ease the patient journey, improve outcomes and reduce healthcare costs. The rise of both Primary Health Networks and Advanced Health Research and Translation Centres in Australia expands the requirement for Australia's Practice Based Research Networks (PBRNs) to incorporate a focus on integration. However little is known about the ways in which PBRNs can help align and coordinate different parts of the health care system. Aim/Objectives: To conduct a scoping review to examine how PBRNs have been used to foster integrated care across the healthcare system. Method(s): Our scoping review used the PRISMA-ScR framework and was based on Valentijn's conceptual framework for integrated care. Two independent reviewers used CovidenceTM to search titles, s, and full texts in Ovid Medline, EMBASE, CINAHL and Scopus. We sought to identify peer-reviewed empirical studies conducted since 2000 that examined collaboration between PBRNs and the broader healthcare system. We excluded studies that solely used PBRNs for recruitment and those restricted to a single practice. Finding(s): We identified 3022 articles, of which 74 studied primary care PBRNs. Of these, 13 focussed on 'integrated care.' The studies documented collaboration between primary care and a wide range of professions and organisations. Only one explored integration at a clinical, organisational and system level, and few showed how collaborations could be established or maintained. Most prioritised population health rather than clincial care. Implications: While system integration is beginning to be explored as PBRNs evolve, there is a paucity of information on how PBRNs form and foster integration between primary care and the broader healthcare system. An improved understanding of the role of PBRNs in integration is important given the focus on system integration and sustainability within Australia's new 10 Year Plan for primary health care.

The experience of primary care for patients with chronic obstructive pulmonary disease (COPD) who continue to smoke: an interpretative phenomenological inquiry

Background: Studies of adults living with Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges when interacting with healthcare providers and may be exacerbated by unwillingness or inability to quit smoking. However, none have explored in-depth, primary care experiences among patients with COPD in the Australian healthcare setting. Aim/Objectives: The study used Interpretive Phenomenological Analysis (IPA) to explore healthcare experiences of participants in primary care settings amongst current smokers or those who had recently quit smoking. Method(s): The study was guided by principles of IPA and participants' sense-making of their personal and social 'world', particular experiences, events and emotions were explored. Thirteen participants were purposively recruited from 33 responses to social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts. In-depth interviews were held between February and April 2022 by phone or Zoom. Interviews explored healthcare experiences, smoking and stigma. Cross-case analysis was conducted to form group experiential themes. Finding(s): Participants self-reported doctor diagnosed COPD, were living in Australia and aged between 45 to 75 years. Nine were female and 60% were current smokers. Interviews explored experiences of care including access, interpersonal care, coordination, comprehensiveness of services and trust. Participants described how their care experience shifted as primary care adapted care delivery during COVID. Problematic experiences included timeconstrained consultations 'You're a number, and that's where I feel like a sheep and they can stress you out more', having to self-advocate for care and guilt about smoking. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust 'I have an actual great trust for my GP they're awesome, they'll look after you'. Implications: Understanding and valuing the patient experience in healthcare interactions provides insights to how care can be transformed for vulnerable patients living with socially stigmatised illness.

Diagnosing Doctor Google: investigating the relationship between cognitive bias and information behaviour in older Australians accessing vaccine-related online information

Background: Online vaccine misinformation has been rife during the COVID-19 pandemic. An important factor that influences the spread of misinformation online is how people access, use, synthesise and apply information, i.e., their 'information behaviour'. Interpretation of online vaccine-related information is also thought to be influenced by cognitive bias, defined as unconscious errors in thinking causing a misinterpretation of information, which may lead to inaccurate judgments. Only 54 percent of adults over 65 years of age are up to date with both fiveyearly pneumococcal and annual influenza vaccines. Further, vaccine misinformation accessed online is a particular problem in this group. Aims/Objectives: This study aims to investigate: (1) the relationship between information behaviour and cognitive biases amongst Australians over 65 when accessing online vaccine-related information;and (2) how this relationship influences decisionmaking regarding vaccination. Method(s): This qualitative study will involve semi-structured interviews with a maximum variation sample of Victorians over 65 years of age, recruited via a Facebook advertisement using purposive sampling. The Eisenberg and Berkowitz information behaviour model will inform data collection and analysis. Data analysis will draw upon the tenets of Grounded Theory, involving constant comparison, and open and axial coding to assess relationships between a range of cognitive biases on the one hand, and information behaviours on the other. Data collection will continue until data saturation is reached. Finding(s): The findings of the study will highlight how cognitive bias interacts with information behaviour, and how this interaction impacts upon vaccine uptake for older Australians. Implications: Many online environments are designed to manipulate cognitive biases to increase screen-time. Findings will help inform how primary care clinicians can communicate vaccine-related information in this context. Understanding the interaction between cognitive bias and information behaviour will also inform the design of interventions to tackle misinformation, ranging from consulting strategies to online information tools.

IMPLEMENTATION OF THE GLA:D®PROGRAM VIA TELEHEALTH IN AUSTRALIA: A MIXED METHODS PROGRAM EVALUATION

Purpose: Osteoarthritis (OA) affects more than 300 million people worldwide with the knee and hip joints among the most clinically prevalent. Pain, stiffness, and physical disability are hallmark symptoms that impair quality of life. Good Life with osteoArthritis from Denmark (GLA:D®) is an evidence-based program providing education and exercise-therapy for people with knee and hip OA, now offered in 8 countries. A key barrier to GLA:D® is the need to attend 14 in-person sessions over 8-weeks, particularly for those in rural areas or with substantial occupational or family caring responsibilities. In the COVID-19 pandemic we expanded implementation support for GLA:D®in Australia to provide it via telehealth. The aim of this mixed methods project was to evaluate the implementation of GLA:D® via telehealth in Australia using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Methods: Quantitative: People with knee or hip OA who reported completing GLA:D® via telehealth-only or a hybrid model of in-person and telehealth (minimum 3 telehealth sessions) at 3-month follow-up from March 2020-October 2021 were identified from the GLA:D®Australia registry. RE-AIM dimensions were examined descriptively. For the effectiveness domain mean differences [MD, (95% confidence intervals (CI)), effect size (ES)] from baseline to 3-month follow-up were calculated for pain (visual analogue scale, 0-100) and joint-related quality of life (knee injury and osteoarthritis outcome score or hip disability and osteoarthritis outcome score -quality of life sub-scales). Participants rated perceived recovery on a global rating of change (scale -3 to 3;1-3=recovered) and how satisfied they were with the GLA:D® program (scale 1-5;4,5=satisfied) at 3-month follow-up. Qualitative: One-on-one semi-structured interviews were conducted with 23 GLA:D® trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings. Interviews were transcribed and analysed using a reflexive thematic approach guided by the RE-AIM QuEST framework. Results: Reach: 138 people (39 telehealth-only and 99 hybrid model;69% female) completed GLA:D.® Mean (SD) age and BMI were 64 (9) years 29.8 (5.5) kg/m2, respectively. Key themes on patient barriers and enablers for telehealth reach were technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions limiting access to in-person GLA:D® was an enabler. Effectiveness: For telehealth-only, average pain [MD=-10 (95%CI=-16, -4), ES=-0.54] and joint-related quality of life [MD=9 (95%CI=3, 14), ES=0.51] improved significantly. This was similar for hybrid model with average pain [MD=-11 (95%CI=-16, -6, ES=-0.43)] and joint-related quality of life [MD=12 (95%CI=8, 16, ES=0.65)] also improved. At 3-months, 81% of participants reported recovery and 88% were satisfied with GLA:D®. Most physiotherapists who adopted GLA:D® telehealth believed it was as effective as in-person for most patients and felt patients were better able to continue exercising at home upon completion. Adoption: 92 physiotherapists (74 health services) delivered GLA:D® via telehealth. Most physiotherapists who had adopted GLA:D® via telehealth stated it had become a normal part of their practice. Barriers to adoption included preferring, and greater confidence with providing, in-person GLA:D®. Implementation: Both education sessions were attended by 70% (n=96) of participants and 91% (n=125) attended more than 10 exercise-therapy sessions. GLA:D® telehealth implementation involved program modifications, including to assessment, exercise instruction, equipment modifications, and reduced fee structures. Maintenance: GLA:D® telehealth participants completed 3-month follow-ups throughout the entire study timeframe, with 16 (12%) in the final 2 months of evaluation, indicating ongoing participant engagement. Physio herapists stated GLA:D® telehealth was an opportunity for increased program access to immunocompromised, rural, and working patients. Barriers to sustainability identified included lack of personnel capacity, low patient demand, and a need for future telehealth training and support. Conclusions: Telehealth delivery of GLA:D® in Australia during the pandemic was most used as part of a hybrid model, combined with in-person delivery. Patient outcomes following GLA:D® via telehealth were comparable to published data related to in-person delivery, indicating it is an effective method to implement group-based care for OA. Yet, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. This evaluation will guide new strategies and training to support GLA:D via telehealth as a viable mode of program delivery in the future in Australia and internationally.

Implementation of an At-Home, First-Semester Biochemistry Lab Course: A Module Based on Banana Tyrosinase

This paper describes the development of a fully remote upper-class biochemistry lab course. The sudden change to online teaching in the middle of spring semester 2020 had a primarily negative impact on laboratory teaching. These effects were mitigated because the students had done many of the basic hands-on procedures before the switch. A true "at-home"biochemistry lab module was implemented in the fall semester of 2020 to ensure students could have a hands-on lab experience in a remote setting despite the remaining COVID-19 restrictions placed upon universities. The module covered several fundamental concepts and techniques found in a first semester biochemistry lab sequence: extraction and purification of a protein from a sample, and further analysis of the protein. Tyrosinase was isolated and purified from a banana extract followed by kinetic analysis of the enzyme. A key component to the module is an LED light board that, in combination with a cell-phone app, made a simple at-home colorimeter. The module was implemented in three sections of a first semester biochemistry lab course (81 students total) in the fall of 2020, and components of it have been used periodically since. Some of the procedures are now being implemented into normal in-lab sessions. An assessment in terms of a student survey showed that most of the students were able to adapt to this format and felt that their learning was not impeded. © 2022 American Chemical Society.

"It's second best": A mixed-methods evaluation of the experiences and attitudes of people with musculoskeletal pain towards physiotherapist delivered telehealth during the COVID-19 pandemic.

BACKGROUND: Musculoskeletal physiotherapy practice rapidly adopted telehealth during the COVID-19 pandemic, providing a unique opportunity to evaluate the experiences and attitudes of people who would not usually engage with these services. METHODS: A sequential mixed-methods study recruited people with musculoskeletal pain conditions accessing Australian private practice physiotherapist services. Part 1 involved an online survey of telehealth services accessed, treatments and resources provided, self-reported global change in condition, and attitudes toward telehealth. Part 2 involved semi-structured interviews with a subset of survey participants, exploring experiences and attitudes towards telehealth. Quantitative data was reported descriptively. Qualitative data was evaluated using inductive thematic analysis. RESULTS: 172 participants responded to the survey, and 19 were interviewed. 95% accessed video-based telehealth, and 85% reported condition improvement. 84% agreed it was an efficient use of their time, 75% agreed it was financially viable, and 73% agreed their condition was accurately diagnosed. 62% percent believed telehealth should be less expensive than in-person services. Qualitative analysis revealed four themes (17 subthemes), including (i) telehealth had value, but generally perceived as inferior to in-person care; (ii) challenges related to assessment, diagnosis, 'hands on' treatment, observation, communication, and technology; (iii) advantages to access safe, expert, and convenient care; and (iv) importance of supportive technology, including video and supplementary resources. CONCLUSION: Physiotherapist telehealth services provided to people with musculoskeletal pain during the pandemic was valued. However, telehealth was generally perceived as inferior to traditional in-person care, and may be best used as part of a hybrid model of care.

Triage-HF plus: 12-month study of remote monitoring pathway for triage of heart failure risk initiated during the Covid-19 pandemic

Background: The Covid-19 pandemic necessitated rapid adoption of remote monitoring across cardiovascular patient cohorts. Most patients with cardiac implantable electronic devices (CIEDs) are now able to be remotely monitored using either scheduled, patient- or threshold-triggered transmissions. The validated Triage Heart Failure Risk Score (Triage-HFRS) is a medical algorithm within company-specific CIEDs that can risk-stratify patients as low-, medium- or high-risk of worsening heart failure (WHF) in the next 30 days based on integrated monitoring of physiological parameters. Building on a previous proof-of-concept of the Triage-HF Plus pathway, we integrated remote data with simple 5-question telephone triage within a clinical pathway to identify WHF during the first year of the Covid-19 pandemic. Purpose: Prospective evaluation of clinical remote monitoring pathway integrating Triage-HFRS with protocolised telephone triage (Triage-HF Plus pathway). Methods: Prospective, real-world evaluation of clinical pathway serving a large urban region over a 12-month period, using data from April 2020 to April 2021 (initiated during the first wave of Covid-19 pandemic in the UK). From a population of 435 patients with CIEDs, 87 high Triage-HFRS alerts were received and patients contacted for telephone triage assessment. Screening questions were designed to identify episodes of WHF and non-HF events. Intervention was at discretion of the clinical practitioner and in line with guideline-directed practice. A consecutive sample of 115 medium risk scores received the same triage. Results: Successful contact was made with 72 (82.8%) high-risk patients. Classification for high scoring patients confirmed on triage included isolated heart failure (18.3%), heart failure concurrent to medical problem (5.7%), alternative medical problem (10.3%), and recent hospital admission (8.0%);triage reassured absence of acute cause of high score in 40.2%. The sensitivity and specificity for detection of WHF was 87.9% (0.77-0.99) and 59.4% (0.50-0.69) respectively. Positive and negative predictive values were 40.3% and 94.0%, respectively. Overall accuracy was 66.2%. Conclusions: The Triage-HF Plus pathway served as a useful remote monitoring tool for identifying patients with WHF whose care had been otherwise disrupted by the Covid-19 pandemic, allowing timely intervention and cementing the longer-term role for such models of care delivery. Crucially, in this multimorbid, high-cost population, relevant non-HF issues were also identified. The high negative predictive value further highlights the potential of proactive surveillance over conventional, periodic follow up.