Nurse-led virtual care successfully manages heart failure patients with features of early clinical deterioration: an 18 month prospective analysis

Abstract Introduction Heart failure (HF) nurses are instrumental in providing patients with the knowledge and skills required to successfully self-manage their condition. Education focusing on self-care strategies, particularly early recognition of worsening heart failure (WHF) symptoms, empowers patients to access timely support. Prompt intervention when initial signs of WHF emerge can prevent the progression of fluid overload, alleviate symptoms and decrease the likelihood of acute decompensation. We sought to evaluate patient self-reported WHF symptoms and the effectiveness of nurse-led virtual care in managing early clinical deterioration in HF. Background The HF nursing team delivers personalised self-care education to all HF patients. A nurse-led virtual telephone clinic operates every weekday. Patients experiencing ≥1 symptom of WHF including dyspnoea, fatigue, oedema, weight gain of ≥2kg, cough, orthopnoea or paroxysmal nocturnal dyspnoea (PND) are instructed to contact the nurse-led virtual clinic. Clinical assessment includes symptoms, weight and when available blood pressure, heart rate, renal function and natriuretic peptide levels. Where indicated, HF diuretic therapy is commenced or up-titrated remotely. Virtual follow-up occurs after 3 days to evaluate treatment response. Patients demonstrating signs of acute HF decompensation or those failing to respond to or experiencing worsening symptoms despite diuretic optimisation are rapidly scheduled for face-to-face (F2F) clinical review. If PND is reported, a same day appointment is issued. Methods A prospective evaluation of nurse-led virtual clinics (January 2024-June 2025) was performed. Inclusion criteria encompassed patients with confirmed HF diagnosis reporting ≥1 symptom of WHF. Patients without confirmed HF diagnosis and those reporting concerns unrelated to WHF were excluded. Results 244 patients underwent prospective assessment, 145 (59.4%) were male, 99 (40.6%) were female with a mean age of 78.04±11.50 years. 151 (61.9%) had HFrEF and 93 (38.1%) HFpEF. 108 (44.3%) presented with 1 symptom, 90 (36.9%) with 2, 41 (16.8%) with 3 and 5 (2.0%) with 4 symptoms (Table 1). Of this, 158 (64.8%) patients were managed through virtual care and 86 (35.2%) received appointments for F2F medical evaluation (Figure 1). Of the 158 patients managed virtually, 121 (76.6%) achieved clinical stabilisation virtually and 37 (23.4%) required F2F appointments after their virtual follow-up (Figure 1). Conclusion Nurse-led virtual care successfully resolves early WHF symptoms in 76.6% of patients, underscoring the critical role of HF self-care education and timely HF team engagement. Through rapid assessment of WHF symptoms and virtual monitoring of treatment response, HF nurses can prevent HF exacerbation progression and minimise the requirement for F2F evaluation. This model also allows for swift F2F review of patients who require escalation of care such as those reporting symptoms of acute HF decompensation.Table 1.Baseline Characteristics Figure 1Results