A mixed-model heart failure virtual ward in a UK district general hospital: patient outcomes and inpatient capacity substitution
A Young, J Szymkowiak, S Connelly, N Barber, S Shore, S Smith, D Bloxham, N Harding, A Mcbain, D Ali, S SiddiquiAbstract
Background
Heart failure represents a major and growing burden on the UK healthcare system, affecting approximately 1/50 adults. It is one of the commonest causes of unplanned hospital admission, and heart failure–related readmission following discharge remains frequent. Heart failure accounts for a substantial proportion of emergency admissions, largely driven by inpatient care and recurrent hospitalisation. Hospital admission is associated with physical deconditioning and hospital-acquired complications, highlighting the need for alternative models of care.
Purpose
Heart failure virtual wards aim to deliver acute and subacute care outside the inpatient setting, most commonly in patients’ own homes, allowing close monitoring, rapid optimisation of therapy, early identification of deterioration and timely escalation where required. Recovery at home may reduce exposure to hospital-related harm and support earlier functional recovery. This evaluation assessed the implementation and impact of a mixed-model heart failure virtual ward in a UK district general hospital.
Methods
A prospective service evaluation was undertaken. Baseline data were collected for 150 consecutive heart failure-related inpatient admissions over the six months prior to virtual ward implementation, including inpatient length of stay, total bed-days utilised and 30-day heart failure–related readmission rates. The virtual ward was evaluated over 14 weeks, during which 25 patients were enrolled. Inpatient bed-days were defined as the index admission prior to transfer, and virtual ward days as days of active, clinician-led out-of-hospital care. A reference inpatient bed-day cost of £415 was used to estimate inpatient cost-equivalent activity.
Results
Baseline admissions accounted for 1,496 inpatient bed-days, equating to a mean length of stay of 9.97 days per admission, with 30-day heart failure–related readmission occurring in 51/150 (34%). Baseline characteristics, including left ventricular ejection fraction, were broadly similar between cohorts. Virtual ward patients accrued 190 inpatient bed-days followed by 229 virtual ward days, representing a mean of 7.6 inpatient days and 9.16 days of out-of-hospital care per patient. Thirty-day heart failure–related readmission occurred in 2/25 (8%). The 229 virtual ward days represent active care delivered without use of an inpatient bed, corresponding to an inpatient cost-equivalent of approximately £95,000 over the 14-week evaluation period.
Conclusion
A mixed-model heart failure virtual ward was feasible in a UK district general hospital and enabled sustained, clinician-led management to be delivered safely outside the inpatient setting. This approach supported earlier transition from hospital while maintaining close clinical oversight during a high-risk period, allowing patients to recover in their own homes and demonstrating patient-centred benefits alongside more efficient use of inpatient capacity.