Abstract 305: Characteristics of Heart Failure Patients Referred to the Bridge Transitional Care Clinic By Time to Readmission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
George Cholack ◽  
Joshua Garfein ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Kim Eagle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Transitional Care ◽  
Discharge Planning ◽  
Nyha Class ◽  
Index Admission ◽  
Post Discharge ◽  
Care Clinic ◽  
Early Readmission

Background: Readmission reduction initiatives emphasize prompt follow-up post-discharge. Identifying factors that influence early readmission may inform discharge planning. We compared characteristics of heart failure (HF) patients (pts) based on time to readmission to determine which pt characteristics were associated with early readmission. Methods: Pts referred to the BRIDGE clinic following index admission for HF from 2008-2017 were eligible. Demographics and inpatient clinical characteristics were compared between 1) pts who were and were not readmitted within 30 days post-index discharge, and 2) pts who were readmitted early (0-7 days post-discharge) versus late (8-30 days post-discharge). Results: Of 978 HF pts, 226 (23.1%) were readmitted within 30 days. Compared to those not readmitted, 30-day readmits were more likely to be male, white, and have higher NYHA class, longer index stay, ICU admission during index admission, and lower Hgb, higher Cr, and higher BUN during index admission. Among those with a 30 day readmit, 56 (24.8%) were readmitted within 7 days of discharge. Early readmits were more often female (p=0.07) and had index stays in the ICU (p=0.07). Conclusion: Pts readmitted within 30 days had more complicated hospital courses than those not readmitted, and those readmitted early had higher incidences of females and index stays in the ICU. Efforts to define a high risk subset of HF pts likely to be readmitted early and targeting them for enhanced discharge planning is warranted.

Abstract 304: Characteristics of Acute Coronary Syndrome Patients Referred to the Bridge Transitional Care Clinic By Time to Readmission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
George Cholack ◽  
Joshua Garfein ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Daniel G Montgomery ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Transitional Care ◽  
Discharge Planning ◽  
Post Discharge ◽  
Care Clinic ◽  
Icu Admission ◽  
Coronary Syndrome ◽  
Female Sex ◽  
Increased Risk ◽  
Early Readmission

Introduction: Prompt follow-up post-discharge is recommended by many readmission reduction initiatives. Identifying predictors of early readmission may inform discharge planning. We compared characteristics of acute coronary syndrome (ACS) patients (pts) based on time to readmission to determine factors associated with early readmission. Methods: Pts referred to the BRIDGE transitional care clinic following index admission for ACS from 2008-2017 were eligible. Demographics and inpatient clinical characteristics were compared between pts readmitted early (0-7 days post-discharge) versus late (8-30 days post-discharge). Multivariable logistic regression models were created to identify independent predictors of early readmission. Results: Of 1220 ACS pts, 198 were readmitted within 30 days; 70 (35.4%) were readmitted early, and 10.0% of these were readmitted for ACS. Early readmissions were more likely to be female, have an ED visit prior to readmission, and have an index ICU admission. Female sex [OR: 2.26, 95% CI: 1.23, 4.16] and ICU admission [OR: 2.20, 95% CI: 1.14, 4.24] were both independent predictors of early readmission. Conclusion: Female sex and ICU admission during index were associated with roughly twice the odds of early readmission. Non-white pts were also more often readmitted early (p=0.05), suggesting potential care disparities in this population. Future studies to identify pts at increased risk of early readmission and efforts to reduce disparities are warranted.

Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Sara Jones ◽  
Anna Kucharska-Newton ◽  
Janet Freburger ◽  
Walter Ambrosius ◽  
...  
Keyword(s):  
Transitional Care ◽  
Discharge Planning ◽  
Care Transitions ◽  
Cluster Randomized Trial ◽  
Stroke Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Exact Test ◽  
Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

OP39 Evaluation Of Discharge Planning And Transitional Care For The Elderly

2018 ◽  
Vol 34 (S1) ◽  
pp. 15-15
Author(s):  
Maggy Wassef ◽  
Marc-Olivier Trepanier ◽  
Sylvie Beauchamp
Keyword(s):  
Readmission Rate ◽  
Transitional Care ◽  
Discharge Planning ◽  
Grey Literature ◽  
The Elderly ◽  
Narrative Synthesis ◽  
Local Data ◽  
Post Discharge ◽  
Level Of Evidence

Introduction:According to our local data, elderly patients accounted for 14 percent of the population yet, represent 58 percent of hospitalization and, they are more likely to return after discharge. These patients are more likely to return to the hospital following discharge. In order to meet ministerial target for length of stay of patient on a stretcher, the UETMIS-SS was requested to evaluate interventions aiming to improve the fluidity of patient trajectories in the acute care services. The objective of this health technology assessment is to evaluate the effectiveness of discharge planning and transitional care interventions aiming at reducing the readmission rate of the elderly.Methods:An umbrella review was conducted following the PRISMA statement to summarize the scientific evidence. The search was conducted in five databases along with the grey literature search. Two reviewers independently performed the study selection, the quality assessment and the data extraction. To better illustrate the activities and the healthcare professionals (HCP) involved in the interventions, an analytical framework was developed. Results were summarized in a narrative synthesis. The contextual and experiential data were collected through interviews with HCP and directorates from different settings. The level of evidence was and a committee was then held to elaborate the recommendations.Results:In the nine systematic reviews included in the narrative synthesis, three models were identified: Post-discharge planning and follow-up by the same HCP was established to be effective in reducing the readmission rate. Discharge planning interventions with follow-up by non-specific HCP have been shown to be promising, while discharge planning without follow-up after the hospital discharge has shown to be ineffective in reducing the readmission rate.Conclusions:An individualized discharge plan, coordination of services and follow-up performed by the same HCP is established to be effective in reducing readmission rate.

scholarly journals Designing an eHealth Coaching Solution to Improve Transitional Care of Seniors’ with Heart Failure: End-User Needs

2021 ◽  
Author(s):  
Jessica Rochat ◽  
Alexandra Villaverde ◽  
Helge Klitzing ◽  
Tore Langemyr Larsen ◽  
Martin Vogel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Transitional Care ◽  
Psychosocial Support ◽  
Informal Caregivers ◽  
Information Access ◽  
User Needs ◽  
End User ◽  
Post Discharge ◽  
Transfer Of Information

Based on scientific studies, heart failure is the principal cause of hospitalization among seniors. More than 50% of elderly with heart failure are readmitted to hospital within six months. Readmission is linked with poor compliance with medical treatment and recommendations, emphasizing the need for a tool to help seniors better comply with post-discharge measures. The goal of this study was to identify end-user needs for the development of a coaching solution aiming to support elderly patients but also formal and informal caregivers. End-user needs were identified through interviews with the three end-user profiles: seniors with heart failure and formal and informal caregivers. The results present six categories of needs: daily treatment follow-up; healthcare network communication; transfer of information; synchronization with current digital tools; information access; and psychosocial support. The identified needs will help to develop an eHealth solution to improve care management and coaching after discharge.

Abstract 095: Lessons Learned from the BRIDGE Registry: Major Findings From 8 Years of BRIDGE

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Morgan Bradford ◽  
Rachel Krallman ◽  
Colin McMahon ◽  
Daniel Montgomery ◽  
Eva Kline-Rogers ◽  
...  
Keyword(s):  
Transitional Care ◽  
The United States ◽  
Lessons Learned ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Patient Reported ◽  
Comorbidity Scores

Background: Readmissions after cardiac hospitalizations are frequent and costly in the United States. Delays in follow-up and lack of adherence to guidelines may contribute to high unplanned readmission rates. Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner (NP) led, transitional care clinic for cardiac patients, aimed at reducing readmissions. Data on patients referred to BRIDGE has been collected since 2009; herein we report a summary of significant findings from these data. Methods: A qualitative review of results and conclusions from all published abstracts, oral presentations, and papers from the BRIDGE registry (June 2008-August 2015) was conducted. Content analysis was used to synthesize findings across studies. Results: Data from 3982 patients referred to BRIDGE have been collected. Seven themes were identified in the analysis of BRIDGE publications. During BRIDGE, NPs focused on medical history, symptoms, medication management (in 24.8% of visits), patient education, and referrals. In addition to addressing provider priorities, addressing patient concerns (daily living and clinical questions, feelings and fears) was highly salient, resulting in a high level of patient-NP connectedness as evidenced by high patient-reported scores on the Consultation and Relational Empathy scale (mean 43.5 ± 2.8; possible range 0, 50) and the Patient-Doctor Relationship Questionnaire (mean 43.05 ± 3.1; possible range 5, 45). Readmissions within 30 days were consistently lower for acute coronary syndrome (ACS) patients who attended BRIDGE compared to those who did not (6.4% v. 13.1%; p<0.01); similar results were not seen in heart failure (HF) (15.4% v. 15.7%; p=0.944) or atrial fibrillation (AF) (8.5% v. 5.2%; p=0.343) patients. A spike in HF readmissions was seen between 8-14 days post-discharge, suggesting the need for a sooner appointment. However, follow-up within 7 days of discharge did not show reduced readmissions in HF patients. AF readmissions were also difficult to avoid; in a subset of AF patients readmitted within 30 days, 51.1% (n=23) were readmitted for non-AF diagnoses. High risk patients (i.e. those with an adverse event before BRIDGE) were older, had higher Charlson comorbidity scores, and were more likely to have depression. However, marriage was associated with fewer readmissions. Conclusions: Data from the BRIDGE registry have shown that clinic attendance reduced ACS readmissions; has characterized older, depressed patients with higher Charlson comorbidity scores as being those most likely to be readmitted; and has identified areas for improvement in transitional care (e.g. AF and HF) where readmissions are difficult to avoid. Continuous quality improvement and real-time monitoring of patient outcomes have translated this research into more prompt transitional care, illustrating the importance of registry-based research.

Abstract 338: BRIDGE: A Post-Discharge Transitional Care Model in over 1600 Cardiac Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Rachel Sylvester ◽  
Minnie Bluhm ◽  
William Froehlich ◽  
Meghana Subramanian ◽  
Alison Wiles ◽  
...  
Keyword(s):  
Transitional Care ◽  
Care Program ◽  
Clinic Visit ◽  
Cardiac Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Care Clinic ◽  
Charlson Comorbidity Score ◽  
History Of

Background: Current legislation imposes financial penalties for high 30-day readmissions for AMI. BRIDGE is a NP-led, post-discharge transitional care program for cardiac patients, aimed at ensuring prompt follow up (f/u; in 14 days) and care coordination. Herein we report the effect of BRIDGE on readmissions in over 1600 cases. Methods: Retrospective data was abstracted for patients referred to BRIDGE including demographics, comorbidities, medications, days to f/u, and 6-month outcomes by diagnosis. Results: Of 1955 patients referred to the BRIDGE clinic, 271 (13.9%) were excluded for adverse events prior to their visit (ED visit n=60, readmission n=193, or death n=14) or missing data (n=4). 1210 (71.9%) of patients from the remaining sample (n=1684) attended BRIDGE. Diagnoses included: ACS (n=462, 27.6%); angina (n=207, 12.4%); CAD (n=196, 11.7%); AFib (n=247, 14.7%); CHF (n=316, 18.9%); or other (n=256, 15.2%). With the exception of mental health disorders (35.4% v. 29.1%, p=.012) there were no baseline differences (including the Charlson Comorbidity Score) between non-attendees and attendees (Table 1). ACS attendees, compared to non-attendees, had a trend toward lower 30, 60, and 90 day readmission rates (Table 2). This was not observed for other diagnoses. Conclusions: A NP based transitional care clinic visit early post-discharge appears to reduce early readmissions for patients with an ACS, but in this study did not impact other cardiac conditions. Also, patients with a history of substance abuse or depression are significantly less likely to attend BRIDGE appointments. To avoid a lapse in care, these patients may need prompt f/u with their PCP or cardiologist to help reduce early readmissions.

Abstract 084: Avoiding Heart Failure Readmissions

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Houda Abdallah ◽  
Colin McMahon ◽  
Rachel Krallman ◽  
Todd Koelling ◽  
Melvyn Rubenfire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Guideline Adherence ◽  
Transitional Care ◽  
Index Hospitalization ◽  
Readmission Rates ◽  
Adherence To Guidelines ◽  
Care Clinic ◽  
The Mean ◽  
Provider Adherence

Background: Heart failure (HF) has high in-hospital mortality and is associated with high readmission rates. Reasons for and ways to avoid HF readmissions are unclear. We explored readmission diagnoses and guideline adherence, as a proxy for avoidability, among patients readmitted after index hospitalization for HF. Method: From 2008-2014, 3381 patients were referred to the BRIDGE transitional care clinic. Retrospective data was derived for 64 of the 154 HF patients who were readmitted within 30 days. Patients were assigned cohorts by readmission diagnosis: “HF or HF related,” “non-HF related other cardiac,” or “non-cardiac, non-HF related.” Patient and provider adherence to ACCF/AHA HF guidelines, including sodium and fluid restrictions, weight monitoring, outpatient follow-up, and medication, were assessed to determine readmission avoidability. Results: Data were collected for 64 pts of whom 62 had complete data. The mean age was 70.3±10.3 years; the majority were male (n=40, 64.5%) and white (n=54, 87.1%). HF diagnoses accounted for 58.1% (n=36) of readmissions; 19.4% (n=12) were for non-HF cardiac diagnoses and 22.6% (n=14) were for non-cardiac diagnoses. Overall provider guideline adherence at discharge was high (82.3%). Providers frequently documented providing education on sodium (77.4%) and fluid restrictions (54.8%), as well as daily weights (88.7%). Patients reported compliance with sodium (94.2%) and fluid restrictions (89.2%), daily weights (96.5%), and medications (96.7%). Patients readmitted for HF had lower guideline adherence than non-HF cardiac or non-cardiac diagnoses for both provider (n=26, 72.7%; p=.046) and patient (n=28, 77.8%, p=.248). HF was also the most frequent readmission diagnoses when provider guidelines were not adhered (n=10, 90.9%). Conclusion: Over 40% of HF readmissions within 30 days of discharge were non-HF related, half of which were also non-cardiac. Overall adherence to guidelines for both patients and providers was high, suggesting that many readmissions post-index hospitalization for HF may be unavoidable. When guidelines were not adhered to, patients were more likely to be readmitted for HF related diagnoses. Further research is needed to discern whether further reductions in readmission rates can be achieved through improved guideline adherence.

Abstract 16135: Hyponatremia is Related to Higher 30-Day Rehospitalization and 1-Year Mortality Rates in Patients Admitted With an Acute Coronary Syndrome: TRACE-CORE

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brendan C Merchant ◽  
David D McManus ◽  
Darleen Lessard ◽  
Joel M Gore ◽  
Robert J Goldberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Serum Sodium ◽  
Odds Ratio ◽  
Transitional Care ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Early Readmission

Introduction: Although hospital survival rates are improving among patients admitted with an acute coronary syndrome (ACS), early readmission is common and 1-year survival remains less than optimal. Improved risk stratification during an index ACS admission could direct greater surveillance or transitional care interventions for vulnerable patient populations prior to discharge from the hospital. While hyponatremia is associated with adverse outcomes after acute decompensated heart failure, less is known about whether hyponatremia relates to key post-discharge outcomes in patients discharged from the hospital after an ACS. Hypothesis: Hyponatremia is associated with early readmission and 1-year mortality in hospital survivors of an ACS. Methods: Using data from TRACE-CORE (Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education), a diverse cohort of 2,081 patients discharged after an ACS, we examined the associations of admission hyponatremia (serum sodium ≤ 134 mmol/L) with 30-day readmission and 1-year all-cause mortality. Results: Cohort mean age was 61 (SD 11.3) years, 34% were women and 19% non-white. Hyponatremia was present in 10.9% and patients with hyponatremia had more pre-existing hypertension (p=0.002) and diabetes mellitus (p=0.001). GRACE scores and maximum troponin values were significantly higher in hyponatremic patients (p= 0.001 and 0.05, respectively). There was no significant difference in prior heart failure or home diuretic use between the two groups. Overall 1-year mortality was 4.58% and 30-day all-cause readmission rate was 13.46%. For patients with hyponatremia on admission, unadjusted odds of 30-day readmission were 36% higher (Odds Ratio 1.36, 95% CI 1.00 to 1.85) and 1-year mortality odds were almost 3-fold higher (Odds Ratio 2.79, 95% CI 1.71 to 4.55). Conclusions: Hyponatremia was associated with higher early readmission and lower 1-year survival. Serum sodium levels may represent a cost-effective biomarker of adverse post-discharge outcomes. The potential incremental prognostic information of serum sodium when added to existing readmission and post-discharge mortality risk prediction instruments should be investigated.

scholarly journals Serially measured cytokines and cytokine receptors in relation to clinical outcome in patients with stable heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Bouwens ◽  
A Schuurman ◽  
K.M Akkerhuis ◽  
S.J Baart ◽  
K Caliskan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Primary Endpoint ◽  
Nyha Class ◽  
Cytokine Receptors ◽  
Funding Source ◽  
Compensatory Mechanism ◽  
Blood Samples ◽  
Two Samples

Abstract Background Activation of the inflammatory response in heart failure (HF) may initially serve as a compensatory mechanism. However, on the longer term, this physiological phenomenon can become disadvantageous. Temporal patterns of inflammatory proteins other than CRP have not yet been investigated in patients with stable HF. Purpose We aimed to evaluate the association of 17 serially measured cytokines and cytokine receptors with clinical outcome in patients with stable heart failure. Methods In 263 patients, 1984 serial, tri-monthly blood samples were collected during a median follow-up of 2.2 (IQR: 1.4–2.5) years. The primary endpoint (PE) composed of cardiovascular mortality, HF-hospitalization, heart transplantation, and LVAD. We selected baseline blood samples in all patients, as well as the two samples closest to the primary endpoint, and the last sample available in event-free patients. Thus, in 567 samples we measured 17 cytokines and cytokine receptors using the Olink Proteomics Cardiovascular III multiplex assay. Associations between biomarkers and PE were investigated by joint modelling. Results Median age was 68 (IQR: 59–76) years, with 72% men, 74% NYHA class I-II and a median ejection fraction of 30% (23–38%). 70 patients reached a PE. After adjustment for clinical characteristics (age, sex, diabetes, atrial fibrillation, NYHA class at baseline, diuretics and systolic blood pressure), 7 biomarkers were associated with the PE (Figure). Interleukin-1 receptor type 1 (IL1RT1) showed the strongest association: HR 2.65 [95% CI: 1.78–4.21]) per standard deviation change in level (NPX) at any point in time during follow-up, followed by Tumor necrosis factor receptor 1 (TNF-R1): 2.25 [1.66–3.08], and C-X-C motif chemokine 16 (CXCL16): 2.18 [1.59–3.04]. After adjustment for baseline N-terminal pro–B-type natriuretic peptide, high-sensitive troponin T and C-reactive protein however, only IL1RT1 and TNF-R1 remained significantly associated with the PE. Conclusion Repeatedly measured levels of several cytokines and cytokine receptors are independently associated with clinical outcome in stable HF patients. These results suggest that repeated measurements of these biomarkers, in addition to established cardiac biomarkers, may contribute to personalized risk assessment and herewith better identify high-risk patients. Figure 1. Associations between levels of cytokines and cytokine receptors and the primary endpoint. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the Jaap Schouten Foundation and the Noordwest Academie.

scholarly journals Improvement of the heart failure patient process for the prevention of new events through tele-education and continuous tele-optimization of the treatment by nursing staff

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Perez Serrano ◽  
CNP Carlos Nicolas Perez Garcia ◽  
DEV Daniel Enriquez Vazquez ◽  
MFE Marcos Ferrandez Escarabajal ◽  
JDD Jesus Diz Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Randomized Study ◽  
Primary Objective ◽  
Control Group ◽  
Close Monitoring ◽  
Chronic Patients ◽  
Face To Face ◽  
Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Introduction patients with heart failure (HF) are especially vulnerable to SAR-CoV-2 infection especially due to their worse prognosis for this disease. Purpose to demonstrate that patients with HF will present similar health outcomes if their education and pharmacological treatment is optimised remotely by a nurse rather than through conventional care. Methods  A single-centre, observational, prospective, non-randomized study was carried out in which two groups were compared. The experimental group had most of their care provided virtually by a nurse who could optimise their medication according to the clinical guides whilst the control group received conventional face-to-face care. During a follow-up period of 6 months, patients included in the study have an initial face-to-face consultation with a cardiologist and an evaluation of the patient where the treatment objectives are established. The rest of the follow-ups were done through videoconsultation with the nurse every 15 days for 6 months where the neurohormonal treatment was optimized and an educational program was carried out with different cardiovascular educational topics. Results   Thirty-seven patients have been included. Sex: 30 men (81.0%) and 7 women (19.0%) Mean age: 67.9 years (12.8). Range 42-87 years. Etiology: 61.2% ischemic and 38.8% non-ischemic mean LVEF at inclusion = 30.2%. A total of 17 patients have completed the study: a 13% average improvement of FEVI, a reduction of NT-proBNP of and improvement in functional heart failure class. The primary objective was to compare the proportion of neurohormonal drugs prescribed, as well as the mean of the maximum doses reached in each after 6 months of follow-up, as well as mean ejection fraction, NYHA class and mean NT-proBNP (Table 1) Conclusions Telemedicine offers us valuable tools that allow us to take care of chronic patients, reducing exposure to the virus as much as possible. Efficient use of virtual tools and human resources makes close monitoring possible. Specialized nursing is a key element in the education, pharmacological optimization and monitoring of these patients. Parámetros analíticos Valores iniciales Valores finales NT-proBNP ( pg/mL) 3469,7 (± 4057,3) 1446,4 (± 1305,2) Creatinina (mg/dL) 1,10 (± 0,24) 1,12 (± 0,39) TFG (mL/min/1,73m2 ) 65,4 (± 21,2) 62,7 (± 23, 6) Potasio (meq /L) 4,5 (± 0,5) 4,6 (± 0,4) Fevi 29,4 % (± 7,2) FEVI 42,7 % (± 9,6)

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