Transition to Telemedicine Practices May Have Streamlined Care in Cardiology Clinics

Joseph Ebinger, MD

Prior to COVID-19, many saw the advent of telehealth as an event that was years, if not decades, away for many specialties, including cardiology.

Now, it is hard to imagine where the field would be without the rapid adoption of telehealth services and a recent study from the Smidt Heart Instituteat Cedars-Seniai Medical Center suggests these new approaches could be helping to streamline practice.

"We were encouraged to learn that access to cardiovascular care was maintained for high-risk and underserved communities during the pandemic," said Joseph Ebinger, MD, director of Clinical Analytics in the Smidt Heart Institute and senior investigator of the study, in a statement. "This same study, however, identified some differences in care that we need to delve into further to better understand."

With adoption taking place in real-time, few studies have examined whether a transition to remote care has led to changes in patient access to care, ordering of diagnostic tests, or medication prescribing. To learn more about potential disparities in these areas, Ebinger and colleagues from Cedars-Sinai Medical Center designed performed a cross-sectional study using data from electronic health records of patients at Cedars-Sinai-affiliated medical centers before and during the pandemic.

For the purpose of analysis, the pre-pandemic period examined by investigators was defined as April 1, 2019-December 31, 2019 and the COVID-19-era period was defined as April 1, 2020-December 31, 2020. For the purpose of analysis, the primary exposure was defined as an in-person or a remote ambulatory visit at 1 of the 31 sites included in the study.

In total, investigators identified 176,781 ambulatory cardiology visits. Of these, 87,182 were in-person visits occurring during the pre-COVID-19 period and 74,498 were COVID-19-era in-person visits. The remaining consisted of 4720 COVID-19 era video visits and 10,381 COVID-19 era telephone visits.

Among all visits, 45% of patients were female, 71.9% were non-Hispanic White, and the mean age of patients was 68.1 (SD, 17.0) years. Upon analysis, investigators found significant differences in the baseline characteristics among patients undergoing the 4 visit types.

Patients using telehealth mediums during COVID-19 were more likely to be Asian, Black, or Hispanic individuals (24 934 pre-COVID in-person visits [28.6%] vs 19 742 COVID-era in-person visits [26.5%] vs 3633 COVID-era video visits [30.4%] vs 1435 COVID-era telephone visits [35.0%]; P < .001 for all comparisons). Additionally, these patients were also more likely to have private insurance and had a greater prevalence of cardiovascular comorbidities (P <.001).

After adjustment for patients and visit characteristics, clinicians had lower odds of ordering any medication or tests, including echocardiograms and electrocardiograms, during COVID-19-era video or telephone visits.

"Our data reveal a reduced rate of testing and prescribing, likely due to a number of factors," added Ebinger. "We see these results as being not obviously negative or positive but a trend that is important to understand. For instance, lower rates of testing and prescribing may-in many instances-reflect reductions in the types of care that are not really needed to achieve good health outcomes while adding costs to the system."

In the aforementioned statement, Ebinger also noted plans to further examine the topic, including whether the change in number of tests could predispose to missed diagnoses.

This study, “Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19,” was published in JAMA Network Open.