Hospital-at-Home Shows Promise Treating Heart Failure, Researchers Say

The Cleveland Clinic’s hospital-at-home program has published research finding that a predominantly virtual care model can be effective for stabilization and treatment of acute heart failure (HF) patients.

The retrospective analysis published as a research letter in JACC: Heart Failure found that the virtual model achieved low readmission rates and was broadly accepted by patients. 

Since 2023, the Cleveland Clinic hospital-at-home (HaH) program in Florida has treated more than 2,800 patients for acute conditions including HF, pneumonia and kidney infection. Eligibility is based on a complete medical evaluation and determined in the emergency department or after an overnight hospital stay.

As a Cleveland Clinic article explains, patients admitted to the program are electronically connected to a clinically integrated virtual command center (CIVC) at a Cleveland Clinic hospital in Vero Beach, Florida, through Bluetooth-enabled equipment they can take home. The equipment facilitates transmission of biometric data as well as bidirectional communication and coordination. A CIVC team of physicians, advanced practice providers and nurses is responsible for directing the care.

“Our results show that IV diuresis, decongestion and titration of therapy for acute heart failure can be accomplished safely at home,” said corresponding author Trejeeve Martyn, M.D., M.S.c.,  director of Heart Failure Population Health for Cleveland Clinic, in a statement. “Outcomes including readmission rates were similar in patients who received care through the virtual model versus in a brick-and-mortar setting.”

Martyn and colleagues retrospectively compared data from patients with acute or decompensated HF treated in the HaH program versus in a traditional hospital setting.

The participants were 395 adults (median age of 79) with an ICD-10 diagnosis of acute HF who received care through one of five Cleveland Clinic Florida locations between April 2023 and August 2024. All 395 passed a geographic screening and a subsequent screen for clinical and psychosocial appropriateness for HaH care. Of these, 215 patients were approached to enroll in the HaH program, of whom 194 (90.2%) consented to enroll. The remaining 201 patients received treatment in a brick-and-mortar hospital.

“It’s astonishing that 90% of eligible patients in our institution — many of whom had previously been hospitalized for heart failure — opted for the hospital-at-home program,” added Martyn. “At a time when they were acutely ill, dyspneic and concerned enough to come to the emergency department, they still preferred stabilization in their own home over the brick-and-mortar hospital experience.”

Among the results of the study were that 84 percent of patients enrolled in the HaH program completed care without transfer to a brick-and-mortar facility for imaging, testing, procedures or care escalation. They also had a lower 30-day readmission rate than their counterparts in a traditional hospital (12.4% vs 16.9%), although the difference was not statistically significant (P = .255). Mortality at 30 days was highly comparable between the groups (3.6% vs. 3.0%, respectively).

The HaH and hospitalized groups were also similar in terms of increases in guideline-directed medical therapy (GDMT) score and in net changes in mean diastolic blood pressure, mean systolic blood pressure and heart rate between admission and discharge.

Among HaH participants, substantial improvements were noted in all aspects of comprehensive GDMT, with use or titration of all recommended therapies being statistically comparable to rates in the traditional hospital group.

“Patients admitted to the hospital-at-home program were safely decongested using IV diuretics, with significant weight loss and minimal safety events,” Martyn noted. “Our findings suggest that a largely virtual acute care model is effective in improving appropriate GDMT prescribing.”

The next steps for Cleveland Clinic’s HaH program are studies involving larger series of patients and development of a consortium with Mayo Clinic to generate more outcomes data and implement best practices for the treatment of HF and other diseases in a virtual hospital setting.

All of the HaH programs across the country are dependent on Medicare waivers being extended by Congress. A five-year extension of the waiver was included in the spending agreement that was unveiled in Congress in December and then later scuttled. The bill that ultimately passed extended the waiver until March 2025.