Clinical Scorecard: Telemedicine Use and Cardiology Service Utilization in the Post-COVID-19 Era
At a Glance
Category
Detail
Condition
Undifferentiated cardiovascular symptoms among adults referred for cardiology evaluation, including suspected heart failure, coronary artery disease, and atrial fibrillation
Key Mechanisms
The study compared video or telephone cardiology visits with in-person visits and assessed subsequent service utilization and time to cardiovascular diagnosis.
Target Population
Adult Kaiser Permanente Northern California members completing cardiology referrals from June 1, 2020, through May 31, 2022, without specified recent cardiovascular diagnoses, appointments, or hospitalizations.
Care Setting
Outpatient cardiology in an integrated health care system during and after the COVID-19 pandemic.
Key Highlights
Among 5,735 referrals, 70.9% of patients had an initial cardiology visit by telemedicine.
Adjusted odds of a repeat cardiology visit within 90 days were lower with telemedicine overall (OR, 0.77; 95% CI, 0.62-0.95).
For suspected CAD, telemedicine was associated with lower odds of an ED visit within 30 days (OR, 0.67; 95% CI, 0.46-0.98).
Telemedicine was not associated with differences in hospitalization within 30 days or time to cardiovascular diagnosis within 60 days.
The authors reported limitations including brief postpandemic follow-up, possible selection bias, and residual unmeasured confounding.
Guideline-Based Recommendations
Diagnosis
The study assessed time to cardiovascular diagnosis within 60 days after the initial cardiology appointment; telemedicine was not associated with a difference compared with in-person visits.
Management
The study authors reported that findings support consideration of telemedicine options in specialty care delivery models.
A telemedicine-first referral approach was associated with fewer repeat cardiology appointments in this study.
Monitoring & Follow-up
Study outcomes included repeat cardiology visits within 90 days and ED visits and hospitalizations within 30 days after the initial appointment.
Risks
The study found no difference in all-cause hospitalization within 30 days between telemedicine and in-person visits.
The authors noted possible selection bias, residual unmeasured confounding, and brief postpandemic follow-up.
Patient & Prescribing Data
The cohort included 5,735 adults with cardiology referrals: 3,238 suspected AF, 1,615 suspected CAD, and 882 suspected HF. Mean age was 61.3 years; 52.4% were male.
Telemedicine included video and telephone visits and was used by 4,064 patients (70.9%). The study compared visit types; it did not evaluate medication prescribing.
Clinical Best Practices
Interpret the findings in the context of the study’s retrospective design and single integrated health care system.
The study adjusted analyses for demographic, access-related, clinical, and socioeconomic characteristics.
Telephone and video visits were analyzed together because telephone visits were infrequent.
by Scott D. Casey, Matthew D. Solomon, Andrew W. Huang, Alan S. Go, Madeline J. Somers, Jie Huang, Andrea K. Millman, Elisha A. Garcia, Deborah Low, Douglas W. Roblin, Mary E. Reed
When patients with refractory AFib fall into a treatment gap, a collaborative new multidisciplinary clinic from Keck Medicine of USC gives them a way out.
New research identifies metabolic signatures that could help predict which patients with Chagas disease are most likely to develop serious cardiac complications
