Telehealth for Left Ventricular Assist Device Patients: Current Perceptions and Practices in the United States

ABSTRACT

Purpose Telehealth services increased during the COVID-19 pandemic but barriers to expansion of telemedicine use for LVAD patients are not well described. This study evaluated perceptions of telehealth and patterns of use at LVAD centers across the USA. Methods An online, de-identified, 19 question survey was distributed across the USA to 53 LVAD centers participating in the FLIGHT and IDEAL HF working groups. A maximum of one physician and one VAD coordinator completed the survey at each center. Results The 62 respondents included 34 heart failure cardiologists, 11 cardiothoracic surgeons, 7 LVAD advanced practitioners and 10 LVAD RNs who were geographically well distributed across the USA. The majority (73%) of respondents worked at centers managing >75 LVAD outpatients and 66% provided care for LVAD patients living in rural areas. Thirty-seven percent of respondents had completed >10 telehealth visits for LVAD patients, and 90% had used telephone visits and 94% video visits. Most respondents (87%) completed telehealth visits for routine care with only 17% using telemedicine visits for acute issues and 10% for post-discharge visits. Fifty-three percent and 26% of providers did not feel comfortable making antihypertensive or diuretic medication changes, respectively, during telehealth visits. Use of remote patient monitoring (RPM) devices for tracking blood pressure or activity levels was low (Figure top panel). Seventeen percent of providers were unsatisfied with patient care during telehealth visits. The most common barriers to increased adoption of telehealth visits for LVAD patients included patient access to technology and reimbursement considerations (Figure bottom panel). Conclusion Telehealth visits are being used for LVAD patients but provider comfort level with medication changes during visits is low. Improved patient access to technology for RPM and video visits and expanded reimbursement of telehealth services may help to increase telemedicine usage for LVAD patients.