Early data from a heart failure virtual ward programme: clinical and financial considerations

Background

The Virtual Ward is an evolving model of care delivering hospital-level monitoring and treatment to patients at home through structured remote multidisciplinary oversight. Admission pathways include patients awaiting diagnostic investigations, atrial fibrillation management, post–percutaneous coronary intervention care, and heart failure (HF).

Purpose

The Virtual Ward Programme was initiated approximately 18 months ago and requires real-world data to inform its development and safe integration into routine practice. We report early clinical and financial outcomes from HF patients managed within this programme.

Methods

All HF patients enrolled in the Virtual Ward during the first 12 months were included (n=173). Baseline demographic and clinical characteristics were recorded. This retrospective analysis examined clinical outcomes, including 30-day and 90-day HF readmission, alongside financial implications of this model of care.

Results

Patients managed through the Virtual Ward demonstrated low readmission rates compared with international benchmarks, with approximately 8% readmitted within 30 days and 14% within 90 days.

In multivariable logistic regression analysis assessing predictors of 30-day HF readmission, no baseline demographic, clinical, or biochemical variable was independently associated with early readmission. Left ventricular ejection fraction (LVEF) severity, HF aetiology, NT-proBNP at admission, and Virtual Ward length of stay were not associated with 30-day readmission risk.

Multivariable analysis examining predictors of 90-day HF readmission demonstrated that each improvement in LVEF category was associated with a 53% reduction in the odds of readmission, while ischaemic HF aetiology was independently associated with higher 90-day readmission risk.

Median Virtual Ward length of stay was approximately 11 days, comparable to inpatient HF hospitalisation durations reported in Europe (9.5 days), and the Asia-Pacific region (8.5 days), while being slightly longer than UK & Ireland (8 days).

In multivariable linear regression analysis examining predictors of Virtual Ward length of stay, greater severity of left ventricular systolic dysfunction at admission was independently associated with longer duration of care. No significant associations were observed with age, sex, obesity, atrial fibrillation, advanced chronic kidney disease, or NT-proBNP at admission.

The fully absorbed cost of an inpatient hospital bed in Ireland is approximately €1,195 per day, compared with €206 per day for a Virtual Ward bed, representing a cost saving of approximately €989 per patient per day.

Conclusions

Early experience with a HF Virtual Ward Programme demonstrates favourable readmission rates alongside substantial cost savings compared with conventional inpatient care. These findings support the role of Virtual Ward models in delivering high-quality HF care while alleviating healthcare system pressures.Demographic and clinical characteristicsFor image description, please refer to the figure legend and surrounding text.Readmission ratesFor image description, please refer to the figure legend and surrounding text.