Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 11, 2023
Date Accepted: Oct 11, 2023
The Costs and Cardiovascular Benefits to Patients with Atrial Fibrillation of a Fourth-Generation Synchronous Telehealth Program on Mortality and Cardiovascular Outcomes: A Retrospective Cohort Study
ABSTRACT
Background:
Atrial fibrillation (AF) prevalence continues to increase in the modern aging society. Patients with AF are at high risk for multiple adverse cardiovascular events, including heart failure, stroke, and mortality. Better medical care is needed for patients with AF to improve their quality of life and limit their medical resource utilization. With advances in the internet and technology, telehealth programs are now widely used in medical care. A fourth-generation telehealth program provides synchronous and continuous medical attention in response to physiological parameters measured at home. We have previously shown the benefit of this telehealth program for some patients with a high risk of cardiovascular disease, but its benefit for patients with AF remains uncertain.
Objective:
To investigate the benefit of participating in a fourth-generation telehealth program for patients with AF regarding cardiovascular outcomes.
Methods:
This was a retrospective cohort study. We retrospectively searched the medical records database of a tertiary medical center in Northern Taiwan between January 2007 and December 2017. We screened 5,062 patients with cardiovascular disease and enrolled 537 patients with AF, of which 279 participated in the telehealth program and 258 did not. Bias was reduced using the inverse probability of treatment weighting (IPTW) adjustment based on the propensity score. Outcomes were collected and analyzed, including all-cause readmission, admission for heart failure, acute coronary syndrome, ischemic stroke, systemic embolism, bleeding events, all-cause mortality, and cardiovascular death within the follow-up period. Total medical expenses and medical costs in different departments were also compared. Subgroup analyses were conducted on ischemic stroke stratified by several subgroup variables.
Results:
The mean follow-up period was 3.0 ± 1.7 years for the telehealth group and 3.4 ± 1.9 years for the control group. After IPTW adjustment, the patients in the telehealth program had significantly fewer ischemic strokes (2.0 vs. 4.5 events per 100 person-years; subdistribution hazard ratio [SHR] = 0.45, 95% confidence interval [CI]: 0.22–0.92) and cardiovascular deaths (2.5 vs. 5.9 events per 100 person-years; SHR = 0.43, 95% CI: 0.18–0.99) at the follow-up. The telehealth program particularly benefited patients comorbid with vascular disease (SHR = 0.11 vs. 1.16; P for interaction = 0.013). The total medical expenses during follow-up were similar in the telehealth and control groups.
Conclusions:
This study demonstrated the benefit of participating in the fourth-generation telehealth program for patients with AF by significantly reducing their ischemic stroke risk while spending the same amount on medical expenses. Clinical Trial: N/A
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