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Hospital-at-home model effective for heart failure patients

Cleveland Clinic's hospital-at-home program for heart failure was linked to improved guideline-directed medical therapy (GDMT) use and lower readmission rates.

Anuja Vaidya
By
Published: 03 Jan 2025

Not only did a majority of eligible heart failure patients opt to participate in Cleveland Clinic's hospital-at-home program, but the participants demonstrated significant improvements in GDMT use, comparable to in-hospital care, new research reveals.

Following the launch of the CMS Acute Hospital Care at Home (AHCAH) waiver in 2020, hospital-at-home (HaH) care models have proliferated nationwide. As of Nov. 27, 2024, 378 healthcare provider organizations across 39 states had been approved for the waiver.

The research letter published in JACC: Heart Failure described Cleveland Clinic's virtual HaH program and assessed its feasibility, safety and quality relative to traditional brick-and-mortar (BaM) hospitalization for heart failure patients. Cleveland Clinic researchers conducted a retrospective analysis of patients admitted to the program between April 2023 and August 2024. Eligible patients included those aged 18 years with acute heart failure (AHF) who had passed a primary geographic screen and secondary assessment for clinical and psychosocial appropriateness. Clinical screening focused on acuity of care and needs, while the social assessment evaluated the safety of the home environment and access to basic utilities.

A clinically integrated virtual command center runs the virtual hospital-at-home program. Hospitalists and nurses oversee patient care remotely, while community paramedics, nurses and other healthcare workers provide wraparound services to fulfill in-person care needs.

Of 215 patients approached for consent to enroll in the HaH program, 194 (90.2%) accepted and were enrolled. A majority of hospital-at-home patients (84%) completed their home hospitalization without needing to be transferred for imaging, testing, procedures or a higher level of care in the brick-and-mortar setting.

The clinical outcomes of the HaH patients were compared to 201 patients hospitalized in the BaM setting. The 30-day readmission rate was lower in the HaH group (12.4%) compared with the BaM group (16.9%). The death rates between the two groups were similar.

Further, researchers observed that increases in GDMT were similar among patients in the hospital-at-home and on-site settings. Net decreases in mean diastolic blood pressure, mean systolic blood pressure and heart rate between admission and discharge were also similar across the cohorts.

"In our retrospective cohort, we observed that our patients with AHF were safely and effectively managed in a virtually led HaH model with similar outcomes when compared with a cohort in a BaM setting," the researchers concluded. "Further research is needed to understand patient selection better, to develop protocols for GDMT titration and AHF management, and to assess the viability of scaling this model of care."

Quality of care under AHCAH on par with or better than in BaM settings

The research aligns with prior studies that assessed the hospital-at-home model.

Last year, CMS evaluated patient care under the AHCAH waiver, finding that patient experience and outcomes are positive. The agency analyzed several aspects of the AHCAH initiative, including patients' demographic information, clinical conditions treated, care quality relative to brick-and-mortar inpatient settings, patient experience and Medicare spending and utilization.

CMS found that the quality of care provided under the AHCAH program was on par with or better than that provided in brick-and-mortar inpatient settings. Additionally, the AHCAH initiative was linked to lower mortality rates than its brick-and-mortar counterparts.

The agency concluded that the study results "appear consistent with the intentions of AHCAH."

However, the waiver is currently on shaky ground. After two legislative spending packages were cast aside, Congress passed the American Relief Act, 2025, on Dec. 20, 2024. The legislation, which was signed into law, includes only a three-month extension for pandemic-era telehealth flexibilities and the AHCAH waiver, much to the chagrin of industry groups and virtual care stakeholders.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.

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