Assessment of cardiovascular diagnoses associated with telemedicine during and after the COVID-19 pandemic.

Abstract

Background: The COVID-19 pandemic led to widespread adoption of telemedicine, which has persisted in healthcare delivery.

Objective: We aimed to characterize telemedicine use in ambulatory cardiology clinics over two years following the onset of the COVID-19 pandemic.

Methods: Retrospective cross-sectional study from 16 March 2020 to 27 June 2022 in a single-center ambulatory cardiology clinic and telemedicine visits. Mixed effects logistic regression was used to model the association of diagnosis class (based on International Classification of Disease 10th Revision codes) with whether an encounter was scheduled as telemedicine, adjusting for age, sex, race, ethnicity, date, and zip code. This was performed for telemedicine and in-office encounters across 15 University of California Los Angeles (UCLA) Health System ambulatory cardiology clinics.

Results: The analysis included 76,127 patients (49.60% women, age 61.5 ± 17.30 years, 57.27% white, 12.25% Hispanic, 81.79% with zip code in a UCLA Health service area) over 255,674 encounters. Each patient had a median of two encounters (range 1-81). Of all encounters, 29,154 (11.40%) were scheduled as telemedicine. Telemedicine was more likely used in the management of chronic conditions, especially metabolic disorders (adjusted OR [aOR] 2.36, 95% CI 2.19-2.54) and cardiomyopathies (aOR 2.16, 95% CI 1.99-2.34), than for evaluation of undifferentiated signs/symptoms. Telemedicine was less likely used for general exam/screening (aOR 0.49, 95% CI 0.44-0.56) and heart transplant (aOR 0.51, 95% CI 0.40-0.64).

Conclusion: Among the outpatient encounters in this study, the most established use case for telemedicine in cardiology was for care of chronic cardiovascular conditions among nontransplant patients, suggesting that future telemedicine expansion should be targeted toward the most appropriate clinical scenarios.