Key result
Evaluation of dyspnea via telephone visits was associated with a higher adjusted risk of 30-day cardiovascular hospitalization (aOR 1.11) compared to office-based visits.
Why the study?
Virtual visits are increasingly common but lack physical examination and electrocardiogram, leaving the quality of care compared to office visits unclear for common cardiac symptoms.
Does telemedicine (virtual visits) improve or worsen 30-day clinical outcomes and cardiac testing referral rates compared to office-based care in adults presenting with cardiac symptoms?
Cohort (n=992,526)
Yes
Does telemedicine (virtual visits) improve or worsen 30-day clinical outcomes and cardiac testing referral rates compared to office-based care in adults presenting with cardiac symptoms?
Answers are grounded in this paper and cite their sources.
Evaluating dyspnea via telemedicine is associated with reduced cardiac testing and a significantly higher risk of 30-day heart failure hospitalization compared to in-office visits, highlighting the importance of in-person triage and physical examination for this symptom.
Background: An increasing proportion of visits are now delivered via a virtual platform. Virtual visits are limited by the lack of important components of cardiovascular assessment such as physician examination and electrocardiogram. Objectives: The purpose of this study was to evaluate the quality of care delivered by virtual visits compared to office-based visits among adults who sought care for three common cardiac-related symptoms: dyspnea, dizziness, or palpitations. Methods: Retrospective cohort study of 992,526 outpatient visits between January 1, 2017, and December 31, 2021, within an integrated health system, including 356,159 visits for dyspnea, 412,913 for dizziness, and 223,454 for palpitations. We compared the differences in patient characteristics associated with telemedicine visits versus in-office visits, evaluated the referral rates for noninvasive cardiac testing, and examined the association between virtual visits and 30-day clinical outcomes. Results: Among 992,526 visits, 71.5% were office visits, 25.8% telephone visits, and 2.7% video visits. Median age was 59 (IQR: 43-72) years, and 63.1% were women. Patient characteristics associated with increased likelihood of virtual visits included younger age, female sex, being non-Hispanic Black, and being from lower-income households. No association was observed between visit types and 30-day cardiovascular hospitalization for patients with dizziness or palpitations. However, for patients with dyspnea, evaluation via virtual visits was associated with a higher risk of 30-day hospitalization for heart failure (aOR: 1.25; 95% CI: 1.16-1.36 for telephone visits; aOR: 1.45; 95% CI: 1.17-1.80 for video visits). Compared to office-based visits, patients with dyspnea were less likely to be referred for echocardiogram with telephone (aOR: 0.73; 95% CI: 0.72-0.75) or video visits (aOR: 0.92; 95% CI: 0.87-0.98). Conclusions: Virtual visits may be appropriate for some clinical concerns but not all. Optimal alignment of clinical conditions with appropriate care modalities is an important component of a successful telemedicine strategy.
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Lee et al. (2024) conducted a cohort in Cardiac symptoms (dyspnea, dizziness, or palpitations) (n=992,526). Telemedicine visits (telephone or video) vs. Office-based in-person visits was evaluated on 30-day hospitalization for a cardiovascular cause (telephone vs. office visits for dyspnea) (aOR 1.11, 95% CI 1.05-1.18). Evaluation of dyspnea via telephone visits was associated with a higher adjusted risk of 30-day cardiovascular hospitalization (aOR 1.11) compared to office-based visits.
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