Heart failure telemedicine doesn’t seem to be lining up evidence-based care after a recent Stanford Medicine analysis revealed that remotely-managed HF patients received less diagnostic testing and saw serious dips in guideline-directed medical therapy.
- The COVID-19 pandemic changed the way we look at telemedicine, taking it from a cost-effective way to check-in to a care continuity tool.
- Earlier telemedicine studies had focused on pandemic-era care or compared telemedicine versus in-person patients, but its impact on HF was unclear.
With the rising popularity of remote patient management in cardiology, Stanford researchers decided to explore telemedicine’s HF impact by tracking 44 cardiologists who treated 7.7k HF patients while grouping them by their clinician’s telemedicine use patterns.
Researchers ultimately uncovered that patients whose clinicians favored telemedicine underwent dramatically fewer diagnostic tests the more virtual visits they attended:
- ECGs (-70% use).
- Echocardiograms (-30%).
- Natriuretic peptide tests (-34%).
- Chemistry panels (-34%).
But the quality of care didn’t just drop in diagnostic testing, with GDMT and medication orders decreasing as well.
- Higher telemedicine use reduced total GDMT initiation (-20%) and aldosterone antagonist prescriptions (-28%).
- New medication orders also declined across multiple drug classes including beta-blockers, RAS inhibitors, nitrates, and diuretics.
While telemedicine certainly offers access benefits, these findings allude to a potential disconnect between physicians and their patients when relying on remote check-ins.
- Researchers also think that the GDMT reduction likely stems from decreased patient data availability during telemedicine visits like real-time vitals and same-day labs.
- Without real-time blood pressure, heart rate, kidney function, and electrolyte data, clinicians may hesitate to initiate therapies.
The Takeaway
Telemedicine, just like many other newer technologies, is a fantastic tool in a physician’s overall toolbox for treating patients, but this study highlights that its use may lead to unintended consequences for complex heart failure patients if used incorrectly.
