Key result
Telemedicine use in patients with heart failure was associated with a smaller decline in CHF admissions over time compared to unexposed patients (ratio of slopes 1.02; 95% CI 1.02-1.03).
Why the study?
Telemedicine use became widespread during the COVID-19 pandemic, but its impact on clinical outcomes and health care usage in patients with congestive heart failure remained unclear.
Does telemedicine use affect health care usage and outcomes in patients with congestive heart failure?
Cohort (n=22,262)
Does telemedicine use affect health care usage and outcomes in patients with congestive heart failure?
Effect estimate: ratio of slopes 1.02 (95% CI 1.02-1.03)
Telemedicine use in CHF patients during the COVID-19 pandemic was associated with higher overall health care usage over time compared to nonusers, suggesting it facilitated better access or continuity of care.
Should not yet change heart failure telemedicine practices; hypothesis-generating for admission trends in observational cohorts.
BACKGROUND: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. OBJECTIVE: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). METHODS: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score-matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. RESULTS: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). CONCLUSIONS: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it.
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Chu et al. (2022) conducted a cohort in Congestive heart failure (n=22,262). Telemedicine use vs. Unexposed users was evaluated on CHF admissions (ratio of slopes 1.02, 95% CI 1.02-1.03). Telemedicine use in patients with heart failure was associated with a smaller decline in CHF admissions over time compared to unexposed patients (ratio of slopes 1.02; 95% CI 1.02-1.03).
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