Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care

Abstract

Background The COVID-19 pandemic brought about abrupt changes in the way health care is delivered, and the impact of transitioning outpatient clinic visits to telehealth visits on processes of care and outcomes is unclear. Methods We evaluated ordering patterns during cardiovascular (CV) telehealth clinic visits in the Duke University Health System between March 15 - June 30, 2020 and 30-day outcomes compared with in-person visits in the same time frame in 2020 and in 2019. Results Within the Duke University Health System, there was a 33.1% decrease in the number of outpatient CV visits conducted in the first 15 weeks of the COVID-19 pandemic, compared with the same time period in 2019. As a proportion of total visits initially booked, 53% of visits were cancelled in 2020 compared to 35% in 2019. However, patients with cancelled visits had similar demographics and comorbidities in 2019 and 2020. Telehealth visits comprised 9.3% of total visits initially booked in 2020, with younger and healthier patients utilizing telehealth compared with those utilizing in-person visits. Compared with in-person visits in 2020, telehealth visits were associated with fewer new (31.6% for telehealth vs 44.6% for in person) or refill (12.9% vs 15.6%, respectively) medication prescriptions, ECGs (4.3% vs 31.4%), laboratory orders (5.9% vs 21.8%), echocardiograms (7.3% vs 98.%), and stress tests (4.4% vs 6.6%). When adjusted for age, race, and insurance status, those who had a telehealth visit or cancelled their visit were less likely to have an emergency department (ED) or hospital encounter within 30 days compared with those who had in-person visits (aRR 0.76 [95% 0.65, 0.89] and aRR 0.71 [95% 0.65, 0.78], respectively). Conclusions In response to the perceived risks of routine medical care affected by the COVID-19 pandemic, different phenotypes of patients chose different types of outpatient cardiology care. A better understanding of these differences could help define necessary and appropriate mode of care for cardiology patients.

Acute cardiovascular hospitalizations and illness severity before and during the COVID‐19 pandemic

“…Successful telemedicine implementation potentially maintained outpatient care for HF patients 21 . We observed an increase in telehealth visits for CVD after the NC shelter‐in‐place order (data not shown), which was consistent with prior published analyses on outpatient CVD care at our own institution 23 . Providers may also have managed worsening HF symptoms in same‐day access clinics or observation units to prevent hospital admissions 24,25 .…”

“…21 We observed an increase in telehealth visits for CVD after the NC shelterin-place order (data not shown), which was consistent with prior published analyses on outpatient CVD care at our own institution. 23 Providers may also have managed worsening HF symptoms in same-day access clinics or observation units to prevent hospital admissions. 24,25 Additionally, patients may have been more willing to increase oral diuretics than in the past, or they may have had fewer acute exacerba- available TTE data, from up to 1.5 years before hospitalization, which may not accurately reflect the current condition.…”

Hidden in plain sight: the (other) danger of COVID-19

“…COVID-19 has changed the public perception of health access and healthcare. While hospitals’ general workload increased [ 8 ], the outpatient clinic’s attendance had decreased remarkably [ 9 , 10 ]. The same is true to departments previously thought to have hard demand, such as emergency department [ 11 ] or clinic for chronic patients, in need of their regular treatment [ 12 ].…”

Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries

“…43 45 However, a similar strategy cannot be implemented for some routine service delivery systems such as obstetrics care, 65 immunisation of children 66 and cardiovascular emergencies. 67 Thus, the integrated care delivery application during pandemic also needs to ensure the undisrupted provision of these critical routine care services. Alternative service delivery mechanisms such as community-based care, task-shifting using community pharmacists and volunteers for contact tracing and counselling functions, and use digital health technologies for prevention, treatment and follow-up of non-communicable diseases and mental health can spur innovations as a part of the IHSD models in L-LMICs.…”