Learning from the perspectives of older adults with valvular heart disease receiving virtual care: insights from the VISIT study

Older adults with valvular heart disease (VHD) often present with complex comorbidities requiring comprehensive nurse-led assessments and education to support informed choices. Traditionally delivered in-person, these visits transitioned to virtual formats during the COVID-19 pandemic. Little is known about the patient experience and associated impact on care. Understanding the patient perspective is critical to optimising patient-centered care and ensuring equitable and tailored participation in treatment decisions.

To explore older adults’ with VHD perspectives on nurse-led virtual consultations and report on their level of satisfaction, perceived quality of care, and implications for shared decision-making and nursing practice.

We conducted a sequential multi-method observational cohort study. We developed a survey to evaluate patient-reported experience measures across domains of technology usability, communication quality, and learning needs that was administered to a consecutive sample of patients. We conducted individual interviews using purposive sampling to recruit a diverse population. Data was analysed using interpretive description to enhance validity and contextual understanding.

77 (96 %) participants (78 years +/- 7, 42% female) responded to the survey. Most participants (n=70, 90%) reported comfort with technology, increased convenience (n=73, 95%), lower travel costs (n=52, 67%), and perceived lower risk to COVID 19-related infection (n=62, 81%). During consultations, 94% (n=72) reported they easily understood the education and information; most (n=66, 85%) reported they had adequate time to ask questions. Compared to their experiences with in-patient visits, 47 (61%) reported lower anxiety during consultation. We conducted 10 semi-structured interviews and identified 3 distinct themes: (1) proactive preparation and family support, (2) a need to establish rapport and connection, and (3) importance of time and cost savings. Participants reported challenges with digital connectivity and reliance on family to support virtual visits. Together, this data indicated that the virtual delivery of nurse-led consults was well received by most older patients when barriers were addressed.

Nurse-led virtual consultations deliver high-quality, patient-centered care that can facilitate informed choices and decision-making for older adults with VHD. Success is dependent upon robust preparatory resources and support systems to overcome digital literacy barriers. Nurses play pivotal roles in fostering meaningful interpersonal connections and ensuring the patient voice is heard. Findings indicate that incorporating virtual care to augment in-person options may present patient-centered opportunities. Further research is needed to better understand how virtual and in-person care can be optimally integrated to support clinical outcomes, patient preferences, and equitable access to care.