Virtual wards offer alternative care for heart rhythm patients

Patients with acute atrial fibrillation may be able to receive specialist treatment at home instead of being admitted to hospital, according to a study led by researchers at the University of Leicester. The findings suggest that virtual wards, combining remote monitoring with clinical supervision, could provide comparable short-term outcomes to conventional inpatient care for appropriately selected patients. The approach could also reduce healthcare costs and pressure on hospital beds.

Atrial fibrillation (AF) is a common cardiac arrhythmia characterised by an irregular heartbeat originating in the heart's upper chambers. The condition increases the risk of complications, including stroke and heart failure. According to the British Heart Foundation, approximately 1.7 million people in the United Kingdom have been diagnosed with AF. Patients experiencing acute AF may require several days of hospital monitoring and treatment. Virtual wards aim to provide an alternative for patients whose condition can be managed safely outside the hospital.

Similar outcomes after 30 days

The study evaluated a virtual ward model developed at University Hospitals of Leicester NHS Trust. Researchers compared outcomes for patients receiving hospital-level monitoring at home with those treated through conventional inpatient services.

The 12-month evaluation compared 91 patients receiving virtual ward care with 91 patients admitted to hospital. Patients in the virtual ward used electronic tablets and remote monitoring equipment to regularly submit electrocardiogram (ECG) recordings, blood pressure measurements, oxygen saturation readings and responses to questionnaires about AF symptoms. Cardiology specialists, advanced clinical practitioners and consultants reviewed the information and made treatment decisions through a multidisciplinary approach.

Researchers found no evidence of a difference in adverse outcomes between the two groups. Emergency department visits, hospital readmissions, outpatient service use and mortality were similar during the 30 days following discharge. Patients from the virtual ward who subsequently returned to hospital spent slightly longer in emergency beds. The researchers suggested this might be related to a greater likelihood of undergoing a definitive treatment procedure. The findings are encouraging, although the relatively small study does not establish that virtual ward care is equivalent to hospital treatment for all patients with acute AF.

Patient benefits

The economic evaluation suggested potential savings of £642 per patient compared with conventional inpatient care. Reducing hospital admissions could help alleviate pressure on NHS bed capacity, particularly as demand for cardiovascular services increases. Patient satisfaction was also high. According to Professor André Ng, who led the study and directs the University of Leicester's British Heart Foundation Centre of Research Excellence, most virtual ward participants indicated that they would recommend the service.

Sue Armstrong, clinical lead for the virtual ward, said the model provides rapid access to specialist advice and can reduce delays associated with conventional care pathways. However, the researchers also identified limitations. Some patients were reluctant to use digital technology or experienced difficulties operating monitoring equipment at home. Only a small proportion of virtual ward participants were aged 80 or older, raising questions about how widely the results can be applied to older patient populations. Patient selection, digital accessibility and the availability of specialist support will therefore be important considerations for broader implementation.

Continuous cardiac monitoring at home

The Leicester study is part of a wider development in cardiovascular care towards remote monitoring and earlier identification of changes in patients' conditions. As previously reported by us, researchers are also developing wearable sensors designed to monitor cardiovascular signals continuously outside clinical environments. Researchers at the University of New South Wales developed an ultrathin wearable sensor, known as AusculPatch, that can detect physiological vibrations associated with heart activity, breathing and arterial pulses. The lightweight device can be attached to the chest or positioned over an artery, potentially allowing patients with chronic cardiovascular or respiratory conditions to monitor relevant signals at home.

While the Australian technology remains at the proof-of-concept stage, it illustrates how developments in wearable monitoring could expand the possibilities for cardiovascular care outside hospitals. The two approaches address different clinical needs. The Leicester virtual ward provides an organised treatment pathway for selected patients with acute AF, while wearable sensor research focuses on continuous physiological monitoring. Both demonstrate how digital technology could support earlier clinical assessment and reduce the need for hospital-based monitoring, provided that changes in patient condition are reliably detected and acted upon.

Further evaluation

The Leicester findings have provided the basis for MAVIA-NHS, an ongoing multicentre study funded by the British Heart Foundation. The project is evaluating the acute AF virtual ward model across four NHS sites to investigate its effectiveness, scalability and suitability for different healthcare settings. Dr Ahmed Kotb, Honorary Clinical Research Fellow at the University of Leicester, said the research contributes to the development of more flexible models of cardiovascular care beyond hospital walls.

The next phase will help determine whether the results can be reproduced in larger and more diverse patient populations. For now, the study suggests that carefully selected patients with acute atrial fibrillation may be managed at home under specialist supervision without an observed increase in short-term adverse outcomes. Larger evaluations will be needed to establish the model's long-term clinical and economic value.