Virtual wards could offer alternative to hospital care for heart rhythm patients

A Leicester study suggests virtual wards could offer a promising alternative to hospital admission for some acute atrial fibrillation patients. 

The study, published in European Heart Journal Digital Health, was led by cardiovascular experts at the University of Leicester. It showed that patients with atrial fibrillation who received care virtually via an electronic tablet and remote monitoring equipment, experienced similar outcomes to those receiving standard inpatient care. 

Furthermore, the study funded by the Health Innovation East Midlands Evaluation Fund and British Heart Foundation, suggests that the potential cost saving associated with this came to £642 per patient. 

The study also provided the foundation for MAVIA-NHS, an ongoing BHF-funded multicentre study of an acute AF virtual ward across four NHS sites.

Atrial Fibrillation (AF) or atrial flutter is a heart rhythm disorder (arrhythmia) where the upper chambers of the heart (the atria) beat irregularly and out of sync with the lower chambers (the ventricles). Instead of a steady beat, the atria quiver or twitch, which can lead to poor blood flow, blood pooling, and an increased risk of stroke or heart failure. 

AF is the most common type of heart rhythm disorder globally with around 1.7 million people diagnosed in the UK alone according to the British Heart Foundation. 

The 12-month study conducted at the University Hospitals of Leicester NHS Trust, aimed to evaluate the safety and real-world outcomes of an atrial fibrillation virtual ward against the standard in-patient hospital care, as well as the costs associated with both of these. 

Typically, patients with acute AF are monitored for several days in hospital, but the virtual ward allows them to be managed from the comfort of their homes, relieving ongoing pressure on the NHS. 

The study compared 91 patients who were looked after virtually – submitting data, including ECG recordings, blood pressure, oxygen saturation and answers to an AF symptom questionnaire, regularly to specialist Doctors, Cardiac Advanced Clinical Practitioners and Consultants who made treatment decisions locally through a multi-disciplinary team approach, to 91 patients who received inpatient hospital care. 

Researchers found no evidence of a difference in adverse outcomes between the two levels of care. 

Overall, emergency readmissions or visits, outpatient service use and mortality rates were similar between the two groups within 30 days after discharge. However, patients from the virtual ward who later returned to hospital spent slightly more time in emergency beds, which may have been due to the higher likelihood of progressing to a definitive treatment procedure. 

Sue Armstrong, clinical lead for the Virtual Ward, said: “The AF Virtual Ward provides rapid access to specialist input, and has been shown to reduce delays associated with traditional care pathways whilst improving the patient experience. Patients and their families appreciate being able to access the support easily from the team regarding their condition.” 

Professor André Ng MBE, Director of the University’s BHF Leicester Centre of Research Excellence and NIHR Senior Investigator who led the study, said: “It shows promising results for the use of virtual wards in the acute treatment of atrial fibrillation – a growing problem for the NHS in terms of bed availability, diagnostic testing, and clinical capacity. What is also pleasing to see is that patient satisfaction levels were overwhelmingly positive - a vast majority of virtual ward patients responded to say that they were either likely or very likely to recommend this service. 

“However, we know there are still some constraints in terms of patient reluctance and ability to use technology from their home. Only a small number of those on the virtual ward were aged 80 or over and therefore there are some barriers to consider – including patient appropriateness and the ability to upscale it to larger numbers across different clinical sites. More evaluation is needed which we are conducting with other centres but our model shows opportunities for novel ways of care among appropriate patients is possible and can help to reduce NHS burden.”  

Dr Ahmed Kotb, Honorary Clinical Research Fellow at the University of Leicester, added: “Our findings represent an important step towards developing more flexible, digital models of cardiovascular care beyond hospital walls, with the potential to benefit both patients and the NHS. The ongoing MAVIA-NHS study will help us evaluate the wider impact and understand how this approach can be scaled across different healthcare settings."

Nicole McGlennon, Chief Executive, Health Innovation East Midlands said: “This study shows that, for appropriately selected patients with atrial fibrillation, virtual wards can offer a safe and effective alternative to hospital care, while helping to ease pressure on NHS services. During the pandemic, the Health Innovation Networks played a leading role in accelerating the development and adoption of virtual wards. We’re pleased to have supported the development and evaluation of this model in Leicester. This latest study adds to the evidence base for how virtual wards could benefit patients and the wider health system.”