Patients with heart failure (HF) discharged from the hospital who received a telemedicine or in-person follow-up had better outcomes than patients who did not receive prompt HF healthcare during the COVID-19 pandemic, according to results of a study published in the Journal of the American Heart Association.
Patient records from the Duke Health System were analyzed for this study. Patients with HF (N=6918) who were hospitalized between March 2020 and March 2021 were assessed for outcomes on the basis of receiving a telehealth or in-person consultation. Follow-up was defined as a consultation within 2 weeks of hospital discharge. The primary outcome was readmission at 30 days.
During the pandemic, 2681 had an in-person and 526 a telemedicine follow-up, and 3711 had no follow-up. Overall, the patient population was aged median 67 (IQR, 19) years, 45.4% were women, and 51.5% were White. Patients who did not have a follow-up were younger, fewer had Medicare fee-for-service, more had Medicaid insurance, and more lived in a disadvantaged neighborhood (all P <.001).
Among patients who had a follow-up, telemedicine was associated with percutaneous coronary intervention (adjusted odds ratio [aOR], 0.40; P =.030), 30 to 45 mL/min/1.73 m2 estimated glomerular filtration rate (aOR, 0.60; P =.007), mitral or aortic valvular disease (aOR, 0.67; P =.005), principal HF hospitalization (aOR, 0.71; P =.005), and aspirin use (aOR, 0.78; P =.042). Telemedicine was associated with stay-at-home COVID-19 restrictions (aOR, 5.37; P <.001), early COVID-19 outbreak (aOR, 3.34; P <.001), hyperlipidemia (aOR, 1.36; P =.024), discharge to home with home health (aOR, 1.29; P =.023), and hospitalizations in the past year (aOR, 1.28; P =.025).
The 30-day readmission rate was 14.2% among patients who had a follow-up and 23.1% for those who did not (P <.001). Similarly, the 30-day readmission or mortality rates were 14.7% and 24.8%, respectively.
Compared with no follow-up, in-person (aOR, 0.52; 95% CI, 0.45-0.60; P <.001) and telemedicine (aOR, 0.55; 95% CI, 0.44-0.72; P <.001) follow-up decreased risk for 30-day readmission and for 30-day readmission or mortality (in-person: aOR, 0.49; 95% CI, 0.42-0.56; P <.001; telemedicine: aOR, 0.53; 95% CI, 0.42-0.70; P <.001).
This study was limited by only having access to health records within the Duke University Health System and may have underestimated the follow-up rate.
“Patients who received either a telemedicine or in-person follow-up within 2 weeks after discharge had a significantly lower rate of 30-day readmission than those who did not,” the study authors wrote. “These findings provide strong evidence for the use of telemedicine post discharge to reduce the risks of 30-day readmission. Our study also identifies several factors that are associated with the use of telemedicine versus in-person visits. These findings have important implications for adopting telemedicine into routine medical care to improve outcomes in patients with HF.”
Xu H, Granger BB, Drake CD, Peterson ED, Dupre ME. Effectiveness of telemedicine visits in reducing 30-day readmissions among patients with heart failure during the COVID-19 pandemic. J Am Heart Assoc. Published online March 1, 2022. doi:10.1161/JAHA.121.023935