Background Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management. Methods An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR <140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT). Results Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients. Conclusion This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort. Funding Acknowledgement Type of funding sources: None.

Background Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management. Methods An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR <140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT). Results Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients. Conclusion This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort. Funding Acknowledgement Type of funding sources: None.

No abstract

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The pilot phase of the Virtual Ward was funded by Leicester, Leicestershire and Rutland Clinical Commissioning Group and supported by a Digital Healthcare Partnership Award from NHS Innovation (now Transformation Directorate). Background The current model of care for patients with atrial fibrillation (AF) is born out of legacy physician-centred care models. The development and acceptance of digital technology have enabled the advent of novel telemedicine-based models for patients with fast AF. Purpose A virtual AF ward was implemented as a proof-of-concept care model for patients with AF and rapid ventricular response. Methods Patients presenting acutely with AF or Atrial flutter (AFL) to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device (Kardia), a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and complete an online AF symptom questionnaire. Data were uploaded to a digital platform (Dignio) for daily review by the clinical team. Primary outcomes included admission avoidance, re-admission avoidance, and patient satisfaction. Patient satisfaction was assessed using the NHS Friends and Family test (FFT) in addition to narrative feedback. Results There were 50 admissions to the virtual ward between January and August 2022. Twenty-four initial hospital admissions were avoided with patients instead directly enrolled from the outpatient setting and a further 25 re-admissions were appropriately prevented during virtual surveillance, avoiding a total of 49 admissions to hospital beds. Most admissions were in AF 78% (n=39) or AFL 18% (n=9), with two admissions frequently alternating between sinus rhythm and AF 4% (n=2). Mean HR at the time of admission and discharge was 122 ± 26 and 82 ± 27 bpm, respectively. FFT response rate was 90% (n=45), with 100% positive responses. Only one patient declined using the service due to technology related anxiety. None of the patients demanded to unilaterally terminate the monitoring, or stopped using the online platform before being discharged from the virtual ward. Conclusion This is a first real-world experience of an AF virtual ward that demonstrates a potential for reducing the healthcare burden imposed by AF admissions, while providing the holistic and personalised care that AF needs. Work is ongoing to further confirm safety and cost-effectiveness upon progress in a larger patient cohort.