Brief ReportOutpatient Management of Guideline-Directed Medical Therapy for Heart Failure Using Telehealth: A Comparison of In-Office, Video, and Telephone Visits
Section snippets
Methods
We conducted a retrospective study of patients with HFrEF who were seen at Saint Luke's Health System cardiology clinics between March 16, 2020 through March 15, 2021. The electronic medical record (EPIC, Verona, WI) was queried to include patients with international classification of diseases, tenth-revision (International Classification of Diseases, 10th edition) HFrEF diagnosis codes (I50.2, I50.20–23, I50.4, I50.40–43, I42.0, and I25.5). Patients with a HFrEF diagnosis were included
Results
We identified 13,481 outpatient encounters performed for 5439 unique patients with HFrEF. Of these visits, 7045 were in-office (52.3%), 2610 were video (19.4%), and 3826 were telephone visits (28.4%). Overall, 65% of in-office, 59% of video, and 54% of telephone visits were conducted by physicians; the rest were conducted by advanced practice providers. Vital signs including blood pressure were recorded in 100% of in-office, 78.9% of video, and 72.7% of telephone visits (P < .001). Baseline
Discussion
Our study highlights several important findings with respect to GDMT use for HFrEF across outpatient visit types. Video visits were similar to in-office visits with respect to initiation of GDMT. However, adding GDMT during telephone visits was less common than in either in-office or video visits. Loop diuretics were initiated more frequently during in-office visits when compared with both forms of telehealth visits. These data have important implications when considering incorporating
Conclusions
Video visits provided similar performance to in-office visits regarding GDMT optimization in HFrEF, though loop diuretic initiation was less common in all telehealth visits. Telephone visits were associated with lower rates of GDMT initiation compared with in-office and video visits. Health systems should encourage remote visits to include video streaming.
Source of funding
No financial support was received.
Declaration of Competing Interest
The authors declare no conflict of interest relevant to this article.
Acknowledgments
The authors acknowledge Ty Terrell from Saint Luke's Health System for his work on behalf of this article.
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