Introduction: The American Heart Association (AHA) Center for Telehealth aims to address gaps in the telehealth landscape by guiding telehealth integration into outpatient settings for cardiovascular disease risk factor management. AHA’s Patient Solutions and Support team supports this goal by collaborating to develop health care professional (HCP) and patient education resources for telehealth. Purpose: The AHA conducted a cross-sectional survey at health systems participating in the Center for Telehealth’s Learning Collaboratives. The survey goal was to understand patients’ experience, knowledge, and attitudes about telehealth. The results aimed to inform AHA’s patient and HCP telehealth resource development. Methods: Twelve health systems, located across 9 states, invited their patients to complete a 30-question survey hosted online in Qualtrics. The survey was offered in English and Spanish. Included participants were of consenting age in their state and had hypertension, hyperlipidemia, and/or diabetes. Data was analyzed to produce descriptive statistics. Results: A total of 571 complete survey responses were collected. Most participants were female (68.9%), below 65 years of age (81.9%), and represented various races including Black or African American (32.9%), White (26.3%), and Hispanic or Latino (20.1%). Of those who indicated they had health insurance (81.4%), almost half (43.9%) had Medicare or Medicaid. Most participants had a telehealth visit in the last year (70.1%); their top reasons for choosing telehealth were the convenience of telehealth (40.8%) and to save time associated with traveling (25.0%). Participants identified facilitators for telehealth use: lower telehealth appointment costs and/or co-pays for in-person appointments (36.3%), HCPs requesting prescriptions directly after the visit (24.3%), and access to reliable internet connection (21.5%). Participants selected two top resources that would make them more likely to attend a future telehealth appointment: “Telehealth Appointment Prep Checklist” (45.6%) and guidance on “What to Expect During Your Telehealth Visit” (45.0%). Most participants shared that short videos would be most helpful for them to learn about using telehealth (67.1%). Conclusion: Most participants are likely to attend telehealth appointments in the next year (69.2%). To enhance participants’ experiences, short videos, guidance on telehealth visit expectations, and an appointment prep checklist could be developed.
Introduction: Telestroke can enhance the timeliness and overall quality of stroke care for rural populations geographically separated from higher level stroke centers. To help hospitals utilize this resource, the Wisconsin (WI) Coverdell Stroke Program (Coverdell) and American Heart Association® (AHA) partnered with 15 hospital systems for a Telestroke Taskforce (TF) which met monthly June 2021-February 2022. Methods: A TF Charter and Framework guided the work. Framework items included: decision to call, telestroke consult, treatment and transfer decision, feedback, and patent satisfaction. Challenges, successes, WI consensus criteria, WI document development, Get With The Guidelines® (GWTG), resource needs and availability were addressed for these items. A manual and two videos were developed. The first video is a four clinician panel across four hospital systems sharing perspectives on telestroke implementation. Second, a demonstration video of conducting the National Institutes of Health Stroke Scale (NIHSS) via telestroke was produced to assist those unfamiliar with the process. The WI Telestroke Toolkit, which includes the charter, framework and established resources, will be published to the Coverdell website in Fall 2022. Results: Five measures were assessed quarterly Q1 2021-Q1 2022 among WI hospitals entering into GWTG® • Proportion of stroke patients w/ telestroke consult - 16.9ppt increase • Thrombolytic administration rate - 0.2ppt increase • Mechanical endovascular rate - 0.6ppt increase • Median time to consult - 2 minute reduction • Door-in-door-out times - 1 minute reduction Conclusions: Measure improvement, given the timeframe, is likely due to an increased focus on telestroke associated with the TF. As the Toolkit is shared and utilized by hospitals, we are hopeful for continued improvement. The Toolkit will be updated annually. Future considerations are to formally evaluate TS recipient satisfaction.
Aim: The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). Methods: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Background: Rapid Door in Door Out (DIDO) times at primary stroke centers (PSCs) continue to be a challenge. The AHA/ASA Western States Quality Task Force met between 2018-2020 to establish strategies that could be employed at most PSCs to decrease their DIDO times. We assessed the impact of these strategies on DIDO times in a health system with 13 PSCs. Methods: The committee met at regularly scheduled intervals and reviewed the available literature on DIDO to help establish the document. The key strategies include: 1)Target DIDO of ≤ 90 mins, 2) Rapid administration of IV thrombolysis (follow Target: Stroke key best practice strategies), 3) Rapid initiation of a transfer process with consideration of initiation based on examination, 4) Participate in a regional system of care, 5) Integration of telemedicine into the transfer process, 6) Rapid acquisition, interpretation and transmission of neuro imaging, 7) Expedited transport handoff, 8) Mock code strokes which include the external staff who are involved in the transfer process, 9) Prompt data collection, feedback and quality improvement. The key strategies were implemented in April 2021. We compared DIDO in the first three months pre-and post-implementation using the Student’s t-test. DIDO time intervals were also assessed. Results: Thirty-two patients were transferred in the pre-implementation phase vs. 29 in the post-implementation phase. There were no differences in median age (pre 65 vs. post 74), gender (pre 47% female vs. post 52% female), or median NIHSS (11 both pre and post). The DIDO decreased from 120 mins (IQR 95-152) to 79 mins (IQR 63-132) p=0.009. Patient arrival to transfer center call time non-significantly changed from a median of 55 mins (IQR 35-91) to 38 mins (IQR 29-79). Time from transfer center call time to outside hospital physician acceptance had a trend toward improvement from 17 mins (IQR 10-26 mins) to 13 mins (IQR 9-18) p=0.09. Ambulance arrival to ambulance departure non-significantly decreased from 24 mins (IQR 20-34) to 20 mins (IQR 16-25). Conclusion: Implementation of the AHA/ASA Western States Quality Task Force DIDO Best Practice Strategies can decrease overall DIDO times. These strategies can be easily employed at PSCs to improve patient outcomes.
Background & Objectives: Nearly 1 in 4 heart failure (HF) patients are readmitted within 30 days of discharge and nearly half readmitted in 6 months. HF prevalence is projected to continue increasing resulting in over 8 million adults with HF by 2030. Rising prevalence and poor outcomes provide significant improvement opportunities. Health system participation in a quality improvement (QI) initiative promoting adherence to evidence-based scientific clinical practice guidelines informs high quality care and improves patient outcomes. IMPLEMENT-HF, an American Heart Association (AHA) multi-site QI collaborative across inpatient and outpatient settings, uses implementation science and data analysis to improve guideline adherence across the HF care continuum. Methods: The IMPLEMENT-HF program targets the transformation of HF care in seven national regions. Organizations across the care continuum collect baseline and 30-day follow-up HF data and contribute to learning collaboratives. Data sources include HF measures in the AHA Outpatient Pilot Registry and Get With The Guidelines®-Heart Failure (GWTG-HF) inpatient and post-acute data. In addition to quantitative data, qualitative data including needs assessments, model sharing queries, and evaluation surveys are assessed. After establishing benchmark data, performance is evaluated continuously to identify care gaps. Opportunities for HF QI from this analysis emanate from 1:1 site meetings, regional, and initiative-wide learning collaboratives. AHA staff monitor data to recommend improvements, provide consultation, and deliver targeted training and resources to address common guideline adherence barriers. Intended Analyses: Demonstrate improved guideline adherence across the currently participating 60 sites; benchmark clinical outcomes, esp., mortality, against prevailing community norms with a goal absolute reduction in cardiovascular mortality of 5%; and use multi-site collaboration to develop and promulgate implementation strategies. Conclusions: This three-year multi-region QI initiative connects sites to share challenges and strategies, develop resources, and analyze data to foster continuous guideline adherence improvement across the HF care continuum.
