Telehealth Becoming a Preferred Platform for Cardiovascular Care

The COVID-19 threat pushed more people onto telehealth platforms for cardiovascular care, according to new research out of Cedars-Sinai. But it also led to fewer tests and medications.

Those takeaways come from a study recently published online in the Journal of the American Medical Association (JAMA) Network Open. Conducted by researchers at the Los Angeles health system’s Smidt Heart Institute, they point to an increase in the use of connected health for heart health, especially among those who most need access to care.

“We were encouraged to learn that access to cardiovascular care was maintained for high-risk and underserved communities during the pandemic,” Joseph Ebinger, MD, the institute’s director of clinical analytics and senior author of the study, said in a press release. “This same study, however, identified some differences in care that we need to delve into further to better understand.”

That would be the reduction in tests and prescriptions, when compared to patients who visited a doctor in person. It could raise questions as to whether virtual care is used to its full advantage or whether in-person care is too reliant on additional (and expensive) services.

“Our data reveal a reduced rate of testing and prescribing, likely due to a number of factors,” Ebinger said. “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.”

That conclusion – that a telehealth visit is more efficient and less costly – would run counter to critics who say providers conducting virtual visits are more likely to prescribe medications or tests.

Using EHR data, researchers studied almost 75,000 in-person visits and more than 4,700 telehealth visits and 10,300 telephone visits from April to December of 2020 and compared them to a little more than 87,000 in-person visits conducted during the same time period in 2019, prior to the pandemic. Among the data they gathered was the number of medications or follow-up tests, including electrocardiograms and echocardiograms, ordered during each time period.

The numbers indicate that the threat of COVID-19 compelled more people to seek virtual visits, and those people were more likely to be from racial or ethnic minorities and have cardiovascular conditions like hypertension, coronary artery disease, atrial defibrillation or heart failure.

In addition, those more likely to use telehealth also had private insurance, raising questions as to whether Medicare and Medicaid patients are allowed or able to access virtual care – and whether those programs are doing enough to support telehealth.

Ebinger and co-author Susan Cheng, MD, MPH, MMSc, an associate professor at the Cedars-Sinai Department of Cardiology and director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute, said some of the concerning data points may be due to the fact that both patients and providers have to get used to telehealth, and that unfamiliarity may have led to some missed opportunities.

Conversely, they noted that the telehealth platform offered an ideal opportunity to access care for those who didn’t want to risk an in-person visit or were too busy to schedule a visit. In that case, they might have skipped a doctor’s visit altogether if not for the virtual visit.

Ebinger said he next wants to study how changes in physician workloads during the pandemic may have affected clinical outcomes. And he wants to know more about why fewer medications and tests were ordered among the virtual group.

“We plan to next examine if the ordering of fewer tests, such as stress tests, might predispose to missed diagnoses,” he said. “To understand the balance of risks and benefits, we are also investigating whether the fewer tests ordered might actually represent opportunities to streamline away from certain types of care that were not important contributors to health in the prior system of only in-person visits.”