Virtual Heart Failure Clinic (vHFC)

Delivering care through the Internet to patients with heart failure


The virtual Heart Failure Clinic (vHFC) is an internet-based program designed to aid in patient self-management of chronic heart failure (HF). We completed a successful pilot run of the program (click here to view the article), and following that, evaluated its effectiveness with a larger sample of HF patients residing in small urban and rural areas with no access to HF clinics. vHFC examined patient satisfaction, healthcare utilization, and health outcomes following participation in the program.

Background

Unlike the improving cardiovascular disease trends, it is predicted that there will be a rise in the number of cases, hospitalizations and morality rates from HF. This will result in an increasing burden to HF patient quality of life and health care resources. This is especially true in rural areas which generally report even greater numbers of hospitalizations. As programs that support patient self-management and symptom monitoring have been shown to reduce HF hospitalization, we identified a need for a virtual program which will serve smaller communities where physical access to such clinics is currently limited.

Objectives

This study tested an Internet-based HF management program in a group of patients living in areas without access to specialized HF care. If successful, patients in the intervention group will see improved fitness and health (i.e. self-management skills, quality of life, levels of B-type natriuretic peptide - a marker of how hard the heart is working - and healthcare utilization) over a 12-month period compared to HF patients not using the website.

Methodology

Participants were recruited from among cardiac in-patients admitted to the University Hospital of Northern British Columbia for HF. Participants with HF and daily internet access were randomly assigned to a usual care or intervention group following a baseline assessment of their health and lifestyle factors. The usual care group was given educational materials and was only contacted again at 12 months, while the intervention group followed the online vHFC program during this time. Both groups were re-assessed for health and lifestyle factors a year after randomization. As part of the study, participants within the vHFC group logged into the website daily to report their weight and answer questions regarding their symptoms. If a participant entered a value that suggested their condition was getting worse, an alert was generated by the program. A nurse monitored the participants’ health status and contacted them with treatment options if any symptom alerts arose. To promote self-management, the patient also had access to a personal progress page which highlighted their target weight and graphed their own weight (increasing weight being related to fluid retention) over time along with associated alerts as they occured. Recognizing the essential role that the primary care provider has in ongoing HF management, the vHFC also allowed the primary care provider to log onto the program to view their patient’s progress. Under certain circumstances, the vHFC nurse contacted primary care providers to discuss participant health management.