ABSTRACT
Background: Social distancing restrictions resulted in increased utilization of virtual visits (VVs) for arrhythmia care in 2020. Over time, there has been a return to in-person visits (IPVs);however, utilization of VVs may continue to offer advantages for patients. Objective: To assess characteristics of patients durably adopting virtual care. Methods: All appointments in our arrhythmia clinics from March 2020 through November 2021 were analyzed. Completed appointments by EP providers were categorized as VV or IPV. The VV rate was calculated as number of VVs divided by total Visits (IPVs and VVs). Pt characteristics collected included self-identified race and ethnicity as well as age, gender, and insurance status. We compared VV rates amongst patients of different ethnicity, race, and insurance status. We also assessed enrollment in an internet-based patient portal that interfaces with the electronic medical record (EMR) and allows for communication with providers. Results: A total of 6,084 VVs and 10,942 IPVs were included in the analysis. In 2020, 3,550 VVs comprised the majority (52.8% of 6,723) of all outpatient visits, whereas in 2021, this proportion dropped to 24.6% (2,534/10,303) as IPVs became more common. The largest reduction in VV utilization was amongst Black patients (65.2% reduction to a 19% VV rate) followed by Hispanics (62.3% reduction to a 15.8% VV rate). Both groups had a significantly reduced VV utilization rate compared to others in 2021 (P<0.01). There was no significant difference in VV rates for underinsured patients in 2020 or 2021, indicating social but not economic influence on telehealth adoption. Enrollment in the EMR patient portal during the study period was significantly reduced for Black and Hispanic patients (67.4% and 63.1% vs 80.6%;P<0.01) but did not significantly change over time. Conclusion: There was a large reduction in the overall use of VVs for arrhythmia care from 2020 to 2021. The largest reductions in VV utilization were observed in the Black and Hispanic communities, where digital health resources appeared to be underutilized. [Formula presented]
ABSTRACT
Background: Following restrictions imposed by the Covid-19 pandemic, virtual care became frequently employed. The adoption and maintained utilization of virtual care in Cardiac Arrhythmia specialty compared to other parts of cardiology may be greater owing to the nature of the care being given. Objective: To assess digital health resource utilization over time in EP and non-EP providers. Methods: All patient appointments in our cardiovascular medicine clinics at our Center from March 2020 through November 2021 were analyzed. Completed appointments by EP and non-EP providers were categorized as Virtual (VV) or In-Person (IPV). Routine remote device transmissions were excluded from the analysis. The VV rate was defined as the number of VVs divided by total Visits (IPVs and VVs). Results: Over the 21-month observation period, a total of 23,052 VVs (37%) and 39,882 IPVs (63%) were completed. The monthly percentage of virtual visits ranged from 13.5% (N=454/3383) in November 2021 to 97.5% in April of 2020 (N=2123/2178). Compared to other cardiovascular subspecialties, EP had a consistently higher proportion of virtual visits that has persisted throughout the observation period (range 29%-98.4%). With regard to new visits only, in 2020 there were 395/735 (53.7%) new EP VVs vs. 1608/3523 45.6% Non-EP VVs (p<.01). This discrepancy widened in 2021 as there were 524/1353 (38.7%) of all new EP VVs vs. 1400/6181 (22.7%) of all new non-EP VVs. The same widening discrepancy was seen with return visits (RPV). RPVs in 2020 were 3155/4720 (66.8%) EP VVs vs. 9659/16516 (58.5%;p<.01). This discrepancy for RPVs also widened in 2021 as there were 2010/4662 (43.1%) of all RPV EP VVs vs. 4301/19607 (21.9%;p<.01) of all new non-EP VVs. (see attached figure). Conclusion: Cardiac electrophysiologists and arrhythmia patients have adopted and maintained virtual visits to a greater extent compared to other areas of cardiovascular medicine. This may reflect improved at home sensor use and outpatient monitors to facilitate virtual visits in EP. [Formula presented] [Formula presented]