JMIR Publications

ABSTRACT

Background:

Virtual care interventions have the potential to improve access to care and serial medication intensification for patients with chronic heart failure with reduced ejection fraction (HFrEF). However, there is concern that these interventions could unintentionally create or widen existing disparities in care delivery and patient outcomes.

Objective:

To characterize the healthcare utilization patterns of patients who have HFrEF, including specialty type and frequency of in-person and virtual visits.

Methods:

We conducted a retrospective cohort study of patients with HFrEF within a large health system. The primary outcome of interest was odds of a virtual visit during the 1-year evaluation period from 2021-2022. Descriptive statistics were used to evaluate baseline patient demographics and care utilization. A binary logistic regression model was used to model the odds of a primary care or cardiology virtual visit.

Results:

A total of 8,481 patients were included in the analysis. Mean age was 65.9 years (SD 15.1), 5,672 (66.9%) were male and 6,608 (77.9%) were non-Hispanic White. The majority of patients had no cardiology (7,938 (93.6%)) or primary care (7,955 (93.8%)) virtual visits during the evaluation period. Multivariable logistic regression showed significant odds of a virtual visit for patients with certain digital access (e.g., email on file (OR=9.3, p=<0.001), cell phone on file (OR=2.9, p=<0.001), active EHR patient portal (OR=2.8, p=<0.001). Age, race, ethnicity, rurality and social vulnerability index were not associated with virtual visits.

Conclusions:

Only a minority of patients with HFrEF were seen via a virtual visit. Patients with evidence of regular digital technology use were more likely to be seen virtually. Future studies should explore the replicability of these findings and investigate ways to enhance equitable use of virtual visits.