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ABSTRACT:The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy. INTRODUCTION Telehealth: Opportunity to Reduce the Costs and Burden of Cardiovascular Disease and StrokeThe United States finds itself at a pivotal moment in the history of medicine when the annual growth in US healthcare spending increased to 5.3% in 2014, up from 2.9% in 2013, after 5 consecutive years of historically low growth.1 Spending on federal healthcare programs continues to grow significantly.2 Regardless, the need to provide high-quality care continues. More than 85 million Americans (≈26% of the US population) suffer from cardiovascular disease (CVD), and nearly 7 million (2.2%) are stroke survivors. CVD and stroke cost the US healthcare system more than $320 billion and $33 billion, respectively, each year, and by 2030, annual costs of CVD and stroke are projected to balloon to nearly $1 trillion.3 Now more than ever, strategies are needed to increase the value of health care by increasing the quality of care and lowering costs.Enhancing patient access to care via telehealth is an important strategy to help address this challenge. Telehealth, as defined by Office for the Advancement of Telehealth, comprises the use of telecommunications and information technologies to share information and to provide clinical care, education, public health, and administrative services at a distance. 4 Telehealth is a broad term that encompasses many digital health technologies, including telemedicine, eHealth, connected health, and mHealth. Telehealth is a new method of enabling care delivery that has the potential to help transform the healthcare system, to reduce costs, and to increase quality, patient-centeredness, and patient satisfaction. [5][6][7] In particular, telehealth may increase access and convenience for patients with CVD and stroke.8 This is especially true for vulnerable patients with CVD or stroke who, because of their geographical location, physical disability, advanced chronic disease, or difficulty with POLICY STATEMENTSsecuring transportation, may not otherwise access specialty healthcare services. 6,7 Yet, telehealth is underused for the management of CVD and stroke, and several barriers to the successful implementation of telehealth interventions for CVD and stroke exist, including cultural, financial, and legal or regulatory const...

Background— The implementation of Target: Stroke Phase I, the first stage of the American Heart Association’s national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration. Methods and Results— We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42–75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15–25 minutes) could be saved if all strategies were implemented. Conclusions— Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke–recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.