Heart failure outcomes in a virtually run hospital-at-home setting

During the COVID-19 pandemic, the United States (U.S.) Congress enacted the acute hospital-at-home initiative, providing payment parity by diagnosis-related code for patients admitted to either brick-and-mortar (BaM) or hospital-at-home (HaH) settings.1 Despite encouraging data reporting lower rates of hospital-acquired conditions and morbidity, HaH represents ˂1% of Medicare admissions nationally.1 Logistical, financial, and safety concerns—coupled with legislative ambiguity surrounding the Center Medicare and Medicaid Services (CMS) waiver extension—have limited the expansion of this model.2 Indeed, the lengthy 2025 US government shutdown temporarily shuttered many HaH programmes, creating more uncertainty around the model’s future. Previous randomized HaH studies have shown reduced costs and comparable outcomes to BaM but were high-touch, protocolizing daily in-person physician assessments, multiple in-home registered nursing visits daily, and enrolling only patients within several miles of the BaM.3 Unlike conventional BaM care settings that have continuous in-person nursing care, commonly have centralized telemetry monitoring, access to in-person cardiovascular consultative services, and intensive care units, virtually led HaH programmes are unproven in acute heart failure (AHF). With the growing burden of HF globally, a predominantly remote HaH setting may expand model scalability, representing a care model innovation that was accepted by 80% of patients presenting to the emergency department (ED) in a pilot evaluation.4,5