Because of Coronavirus Disease 2019 (COVID-19) pandemic, we were forced to cancel scheduled visits for nearly 150 patients followed in our heart failure (HF) outpatient clinic. Therefore, we structured a telephone follow-up, developing a standardized 23 item questionnaire from whom we obtained the Covid-19-HFscore. The questionnaire, was built to reproduce our usual clinical evaluation investigating patient’s social and functional condition, mood, adherence to pharmacological and non-pharmacological recommendations, clinical and hemodynamic status, pharmacological treatment and need to contact emergency services. The score was used as a clinical tool to define patients’ clinical stability and timing of the following telephone contact on the basis of the assignment to progressively increasing risk score groups: green (0-3), yellow (4-8) and red (≥9). Here we present our experience applying the score in the first thirty patients who completed the four weeks follow-up, describing baseline clinical characteristics and events that occurred in the period of observation.

At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity; however significant difficulties must be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients' centered outcome such as disability free survival. In this perspective, more than one geriatric statement have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients' centered outcomes are considered as primary goals of therapies as well as cardiovascular ones. The current evidences of cardiac surgery in the elderlyAt this time, more than half of cardiac surgery interventions is being performed in patients older than 75 years and this group of patients is steadily rising over time [1].This epidemiological phenomenon has compelled cardiac surgeons to face with a different and more complex clinical scenario represented by patients often accompanied by a larger burden of non-cardiac comorbid conditions and greater illness severity [1]. Nowadays, in the setting of cardiac surgery, elderly patients are more likely to have extensive coronary artery disease and concomitant valvular disease, requiring combined cardiac intervention and need urgent or emergent surgery [2]; nevertheless, new surgery and anesthesiological techniques have resulted in sizeable benefits also for the elderly. However, the clinical and functional complexities of older patient candidate to cardiac surgery have highlighted the significant limitations regarding postoperative predictive power of current cardiac surgery risk scores such as EUROSCORE logistic I and II and STS score [3].Recently authors showed that the predictive value of many currently available risk-scoring algorithms (ACEF, EUROSCORE I and II, STS score) was insufficient to allow a precise and reliable risk assessment in patients undergoing surgical aortic valve replacement or transcather aortic valve implantation with an overestimation of risk using ACEF and conversely an overestimation of it using EUROSCORE or STS score [3].The limitations of these risk models reside on their conceptualization and structure, mainly focused on cardiac specific parameters, and consequently in their inability to capture biological and functional vulnerability present in elderly patient and summarized by FRAILTY concept [4].

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Objectives To evaluate six-month risk stratification capacity of the newly developed TeleHFCovid19-Score for remote management of older patients with heart failure (HF) during Coronavirus disease 2019 pandemic. Design Monocentric observational prospective study. Setting and Participants Older HF outpatients remotely managed during the first pandemic wave. Methods The TeleHFCovid19-Score (0-29) was obtained by an ad hoc developed multiparametric standardized questionnaire administered during telephone visits to older HF patients (and/or caregivers) followed at our HF clinic. Questions were weighed on the basis of clinical judgment and review of current HF literature. According to the score, patients were divided in progressively increasing risk groups: green (0-3), yellow (4-8) and red (≥9). Results 146 patients composed our study population: at baseline, 112, 21 and 13 were classified as green, yellow, and red respectively. Mean age was 81±9 years, females were 40%. Compared to patients of red and yellow groups, those in the green group had a lower use of high dose loop diuretics (p<0.001) or thiazide-like diuretics (p=0.027) and had reported less frequently dyspnea at rest or for basic activities, new/worsening extremities oedema or weight increase (all p<0.001). At six months, compared to red (62.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization (p<0.001). Moreover, ROC analysis showed a high sensibility and specificity of our score at six months (AUC =0.789, 95% CI 0.682-0.896, p<0.001) with a score <4.5 (very close to green group cut-off) that identified lower-risk subjects. Conclusion and implication The TeleHFCovid19-Score was able to correctly identify patients with mid-term favorable outcome. Therefore, our questionnaire might be used to identify low-risk chronic HF patients which could be temporarily managed remotely, allowing to devote more efforts to the care of higher-risk patients which need closer and on-site clinical evaluations.