The burden of stay-at-home mandates resulting from COVID-19 and the hesitancy of people to leave their home early during the pandemic led to an abrupt transition to outpatient telehealth visits for healthcare. In response to the pandemic, some healthcare systems made a rapid switch over to telehealth in the early part of 2020. “The world changed in the early part of 2020 due to the pandemic,” says Brett W. Sperry, MD. “Hospital systems and healthcare providers were forced to figure out how to continue seeing patients in need of care without exposing themselves and others to the potential spread of the virus.”
Patients with heart failure (HF) are especially vulnerable to complications relating to COVID-19 infection, including critical illness and mortality. “Telehealth for patients with HF had been previously studied in a limited capacity, but a rapid transition to almost complete telehealth care has not been previously explored,” Dr. Sperry says. The need to rapidly transition to telehealth highlights the importance of gaining a better understanding of potential adverse outcomes associated with such transitions and can help inform future telemedicine use in the treatment of patients with HF.
Telehealth for Outpatients With HF Allows for Safe Encounters
For a study published in JACC Heart Failure, Dr. Sperry and colleagues looked at whether increased use of telehealth was associated with different outcomes for outpatients with HF. “Due to the pressures of the pandemic, we had an opportunity to review our care patterns and outcomes in patients with telehealth visits versus in-person visits from prior years at our institution,” explains Dr. Sperry. “It was previously unclear whether increased use of telehealth affected outcomes for outpatients with HF.”
Investigators identified 8,263 patients with HF who made 15,421 clinic visits, including 5,246 visits in 2018, 4,951 visits in 2019, and 5,224 visits in 2020. Telehealth was not used in 2018 or 2019, but it was used in 88.5% of visits in 2020. Of note, the dates of these visits were March through June in each of these years. To decrease in-person patient and provider contacts, several physician and advanced practice providers (APPs) were transitioned from hospital service to outpatient telehealth clinics, enabling the study group to leverage its providers to reach more outpatients in 2020 than in 2018 and 2019. Across these years, no differences were seen in the proportion of patients seen by physicians versus APPs or in patients seen by HF specialists versus non-specialists.
Overall, mortality rates were similar for telehealth and in-person visits at both 30 days (0.8% vs 0.7%) and 90 days (2.9% vs 2.4%). Admissions to the ED or hospital were lower after telehealth visits than after in-person visits at 30 and 90 days (Figure). Among hospitalized patients, there was no difference in ICU admissions between telehealth and in-person visits at either 30 or 90 days. “Our findings demonstrate that a telehealth model for outpatients with HF allowed for distanced encounters without increases in subsequent acute care or death,” says Dr. Sperry.
Incorporate Video in Telehealth Visits for Outpatient HF Care
The study team recommends using standardized QOL assessments before outpatient visits to help triage patients with HF to telehealth or in-person visits. They also advise clinicians to consider patient preferences because many people with HF are frail or live far away from the clinic, making telehealth visits more attractive. Telehealth may be especially useful in the outpatient management of patients with HF who have stable symptoms.
“As the pressures of the COVID-19 pandemic wax and wane, our data suggest that telehealth outpatient visits for patients with HF can be safely incorporated into clinical practice,” says Dr. Sperry. “In other research, we looked at rates of prescriptions for guideline-directed medical therapy for HF with telehealth visits versus in-person visits. We found that changes or adjustments to guideline-directed therapy were similar between in-person and video visits, but significantly lower in telephone-only visits. Therefore, we recommend that telehealth visits incorporate video streaming capabilities.”