JMIR Publications

ABSTRACT

Background:

Despite increasing initiatives to promote virtual care, there are limited data describing usage, characteristics or clinical outcomes.

Objective:

To examine the use of virtual care in the management of cardiovascular disease.

Methods:

We used nationwide Danish registries to identify all patients with a first-time diagnosis of atrial fibrillation (AF), heart failure (HF), pulmonary embolism (PE) or acute coronary syndrome (ACS) between 2019 and 2023. Patients were categorized as receiving virtual care if followed up at least once virtually or in-person care if seen solely in-person. We evaluated temporal changes in the use of virtual care, calculated the odds of receiving virtual care and the chance of initiating guideline-directed medical therapy (GDMT).

Results:

45 885 patients with AF, 28 829 with HF, 8 208 with PE, and 10 615 with ACS were followed up. Among these 27.2% (AF), 52.2% (HF), 43.2% (PE), and 37.7% (ACS) had virtual follow-up. The use of virtual follow-up increased during COVID 19 and remained high afterwards. In 2023,16.5%–29.8% of patients’ first follow-up visits were virtual depending on the condition. Patient-specific factors significantly associated with virtual care were: Patients living in cities, for patients with AF (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.23–1.36), HF (OR ,1.39, 95% CI, 1.31–1.47), and PE (OR, 1.17, 95% CI, 1.05–1.30), but not for patients with ACS; and “high frailty”: AF (OR, 1.67, 95%, CI 1.51–1.84 and PE (OR 1.69, 95% CI, 1.38–2.06). Initiation of GDMT was similar across conditions, regardless of virtual or in-person care e.g. for patients with HF, 2.17% initiated sodium-glucose cotransporter-2 inhibitors following a virtual visit, versus 4.77% after an in-person visit (Risk difference, -2.60%, 95% CI, -3.06 to -2.15).

Conclusions:

A considerable proportion of patients (27.2–52.2%), with cardiovascular disease received virtual care. The odds of receiving virtual care varied significantly based on patient characteristics, particularly place of residence and frailty score. Finally, small differences were found in the initiation of new GDMT.