The Utility of Televisits in Heart Transplant Recipients

ABSTRACT

Purpose In the current era, televisits have become requisite to assess patients and monitor their conditions. Heart transplant (HT) recipients represent a complex population with multiple co-morbidities that require frequent evaluation. This study aimed to assess the effectiveness of televist encounters in a post-heart transplant cohort during the COVID-19 pandemic. Methods This was a prospective cohort study of all HT recipients evaluated via a televist between 3/1/20-5/30/20, at a large academic medical center. Patient demographics, baseline medications and details of televisit encounters were collected from electronic medical records. Patients were followed for 3-months from their first televisit for medication changes, in-person visits, hospital admissions, treated rejection or infection episodes and mortality. Results 301 patients were enrolled, mean age was 56.0±15.1 years and 213 were males (71%). Mean time between transplant and first televisit was 49 months. The number of televisits per patient is seen in Figure 1a. Following-televisits 152 patients (50.5%) had medication changes, mostly immunosuppression (43.5%) followed by diuretics (6.0%). 141 patients (46.8%) were seen in person for either a clinic visit or RHC following a televisit. There were 61 ED visits resulting in 42 admissions in 36 patients (12.0%) (Figure 1b). Of those, 17 occurred within 2 weeks of a televisit (40.5%). There were 8 cardiac related admissions (19.0%, 5 due to treated rejection), 14 (33.3%) due to infection, and 6 due to COVID-19. One patient died due to complications of COVID-19 during the study period. Conclusion In this post HT cohort, there was a high rate of admissions, with most readmissions due to non-cardiac or infectious causes. This study calls into question the role of televisits in this complex patient population and merits further study of how they can best supplement usual care to enhance outcomes in patients post-HT.