Telehealth-based CHF treatment as effective as in-person care

Telehealth-based treatment for congestive health failure, or CHF, does not increase the odds of emergency department visits or hospital admissions compared with in-person care, according to new data from Epic Research.

CHF is a long-term condition in which the heart does not pump blood well enough for the body to function normally. Often, blood collects in the lungs, legs and feet of CHF patients.

Virtual care modalities are increasingly used to treat CHF patients, and health systems are seeing positive results. For instance, earlier this year, ChristianaCare announced that its digital hybrid care program had achieved its goal of improving heart failure and hypertension outcomes among Black patients.

Still, there is little data comparing virtual care to in-person care for CHF treatment. For the new study, the research arm of Epic, an EHR developer, assessed data for 62,129 patients diagnosed with CHF between Jan. 1, 2017, and Dec. 31, 2022. The patients selected for the study had five in-person outpatient and/or telehealth visits in the year following their CHF diagnosis.

The data was pulled from Cosmos, a data set representing more than 262 million patient records from 1,500 hospitals and more than 34,500 clinics from all 50 states in America and Lebanon.

The research shows that CHF patients with more telehealth visits were as likely to have an emergency department (ED) visit or hospital admission for CHF than patients who had only in-person visits. Additionally, the researchers conducted a sensitivity analysis of patients with any number of visits in the year after CHF diagnosis, which showed no difference in the likelihood of CHF-related ED visits or admissions based on the volume of telehealth visits.

Thus, researchers concluded that "telehealth may be considered a substitute for in-person office visits for patients with CHF."

Research assessing telehealth's efficacy relative to in-person care has grown amid telehealth's rise and enduring popularity during and after the COVID-19 public health emergency. However, there have been mixed results.

For example, one study published in 2022 showed that telehealth-based care performs on par or better than in-person care on most quality measures evaluated. The study included 526,874 patients, of whom 409,732 received only in-person care and 117,142 participated in telehealth visits.

While patients in the in-person-only group performed better on medication-based measures, those participating in telehealth visits performed better on four testing-based measures. These four measures included patients with cardiovascular disease with lipid panels and patients with diabetes with hemoglobin A1c testing.

Further, the telehealth group performed better than their in-person care counterparts on seven counseling-based measures, including cervical cancer screening, breast cancer screening and tobacco counseling and intervention.

However, research published in June 2024 cautioned that the available evidence comparing telehealth and in-person care is "weak and heterogeneous."

For the study, Johns Hopkins researchers conducted a systematic literature review using various databases, including PubMed, CINAHL, and PsycINFO, to find studies assessing pandemic-era telehealth from March 2020 to April 2023.

They identified 77 eligible studies, of which 43 percent compared telehealth during the pandemic to in-person care before the pandemic. They also identified 12 study outcomes and grouped these into three categories: healthcare utilization, clinical outcomes, and process outcomes.

They found that the differences between telehealth and in-person care regarding healthcare utilization and clinical outcomes were generally small and not clinically meaningful.

Researchers observed some differences between telehealth and in-person care within the process outcomes category. Telehealth was linked to a lower rate of missed visits and higher rates of medication adherence; however, patients receiving initial telehealth visits had lower rates of up-to-date labs and paraclinical assessments.

The researchers further highlighted that most of the studies had a high risk of bias and did not adjust their results for various characteristics of the study population.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.