JMIR Publications

ABSTRACT

Background:

Although telemedicine has been proven to have significant potential for improving cardiac patient care, there remains a substantial risk of introducing disparities linked to the utilization of digital technology, especially for older or socially vulnerable subgroups.

Objective:

We investigated factors influencing adherence to a telemedicine-delivered health education program in ischemic patients, emphasizing demographic and socioeconomic considerations.

Methods:

We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health education meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through standard computer, tablet, or smartphone based on patient preference or availability.

Results:

Out of the 252 patients (median age 70 years [interquartile range: 61.0-77.3 years]; 189 males [75%]), 98 (39%) declined the invitation to participate in the WHEM. Reason for non-acceptance were mostly challenges in handling digital technology (71%) and lack of confidence in telemedicine as an integrative tool for managing their medical condition (43%). Out of the 154 patients who agreed to participate in the WHEM, 40 (26%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level were associated with increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female gender. After multivariable adjustment, higher education level (odds ratio, 2.26 [95% confidence interval, 1.53-3.32], p<0.001) and caregiver with digital proficiency (odds ratio, 12.83 [95% confidence interval, 5.93-27.75], p<0.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism corrected C-index, 0.812), as was the agreement between observed and predicted probability of participation (optimism corrected calibration intercept and slope, 0.010 and 0.948).

Conclusions:

Addressing low digital literacy rates and overcoming cultural bias against remote care are crucial issues to facilitate the broader adoption of telemedicine as an inclusive tool in healthcare