Has Telehealth for Outpatients With Heart Failure Affected Outcomes During COVID-19?

Telehealth visits for outpatients with heart failure (HF) did not increase mortality or a need for acute care, according to a study published in JACC: Heart Failure.

The study was conducted using data from Saint Luke’s Health System, which comprises 16 cardiology clinics, 16 emergency departments, and 12 hospitals in the Kansas City metropolitan area. A retrospective study was performed to compare patient encounters between March 15 and June 15, 2020 with the same periods in 2018 and 2019.

There were 8263 unique patients with HF and 15,421 cumulative health visits during 2018 (n=5246), 2019 (n=4951), and 2020 (n=5224). The majority of encounters in 2020 (88.5%) were telehealth, with no remote encounters conducted in 2018 or 2019.

Patients in 2020 compared with 2018 and 2019 combined were younger (70.5 vs 71.4 years; P <.001); fewer patients were diagnosed with acute HF (6.8% vs 10.2%; P <.001); and more visits were scheduled within 48 hours of appointment (15.9% vs 8.1% P <.001), respectively.

At 90 days after index visit, 1582 emergency department visits, 2447 hospitalizations, 549 intensive care unit admissions, and 400 deaths occurred.

At 30 and 90 days, there were more emergency department visits and hospital admissions in 2018 and 2019 than 2020 (all P £.001) and fewer admissions to the intensive care unit and deaths, with differences reaching significance at 90 days (both P £.013).

Among a propensity-matched cohort of 4541 in-person and telehealth visits each, the only baseline significant difference between cohorts was for the type of insurance (P =.039).

In the propensity-matched analysis, the differences at 30 and 90 days for emergency department visits and hospital admissions remained significantly higher among patients who had in-person visits (all P £.001). For intensive care unit admissions and all-cause mortality, no group differences were observed (all P ³.132).

This study was limited by the inability to adjust the propensity matched cohort for unmeasured cofounders related with the COVID-19 pandemic.

“Rapid adoption of a telehealth model during the COVID-19 pandemic in patients with a diagnosis of HF facilitated continuity of care without increases in subsequent hospital encounters or mortality,” the study authors said. “Longer term multicenter cohorts are needed to better understand the methods to triage patients to telehealth visits and implications on outcomes in patients with HF.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Sammour Y, Spertus JA, Austin BA, et al. Outpatient management of heart failure during the COVID-19 pandemic after adoption of a telehealth model. JACC Heart Fail. Published online October 6, 2021. doi:10.1016/j.jchf.2021.07.003