JMIR Publications

ABSTRACT

Background:

Telehealth is a potential tool to alleviate geographic cardiology specialist shortages, but there is limited data regarding current telehealth use for common cardiology conditions, including atrial fibrillation (AF).

Objective:

We evaluated variation in telehealth use in primary care and cardiology clinics for patients with incident AF in the Veterans Health Administration (VA).

Methods:

We constructed a cohort of patients with AF diagnoses made in the outpatient setting 1/2022-9/2023. We included facility-specialty groups with at least 20 visits for these patients between 1/2022-12/2023. We assessed the association of any video visit and any telehealth use (including phone) for primary care or cardiology visits within 90 days of AF diagnosis with selected patient and facility characteristics using Bayesian logistic regression, including facility random intercepts. We evaluated facility variation in video visit and telehealth use via the median odds ratio (MOR).

Results:

Our cohort included 36,929 patients with new AF, with 80,596 visits across 125 facilities. Of these, 2,088 of 63,835 primary care visits (3.3%) and 323 of 16,761 cardiology visits (1.9%) were delivered by video and 13,403 primary care visits (21.0%) and 3,288 cardiology visits (19.6%) by telehealth. Average age was 74, 2.9% were female, 78% were White, and average CHA2DS2-VASc was 2.8. In adjusted analyses, older age was associated with lower use of video care for both primary care and cardiology and any telehealth for cardiology (e.g., adjusted odds ratio [AOR] of 0.61 [95% credible interval, CrI, 0.42-0.85] for use of video cardiology for patients older than 77). Living >40 miles from care was associated with increased use of both video and any telehealth care for primary care and cardiology (e.g., AOR 1.91 [95% CrI 1.21-3.00] for video cardiology care); rural location was associated with lower odds of using video or any telehealth for primary care (video AOR 0.73 [95% CrI 0.64-0.84]; telehealth AOR 0.89 [95% CrI 0.83-0.96]). There was marked variability across facilities in use of video care (range 0%-17.4% for cardiology, 0%-12.5% for primary care) and telehealth (range 0%-82.6% for cardiology, 3.8%-61.6% for primary care) for this patient population. The facility-level adjusted MOR for video care was 1.97 (95% CrI: 1.77-2.24) for primary care and 4.95 (95% CrI 3.39-7.98) for cardiology. Similarly, the adjusted MOR for any telehealth use was 1.79 for primary care (95% CrI: 1.65-1.96) and 2.61 for cardiology (95% CrI 2.25-3.13).

Conclusions:

Following incident AF diagnosis, telehealth may increase access to primary and cardiology care for Veterans living at a distance, but its use remains lower for older patients and those in rural geographies. There was significant variation in telehealth use across facilities not explained by differences in patient and facility characteristics. Standardizing telehealth use across VA facilities may improve access to AF care.