The association between telemedicine use and changes in healthcare utilization and outcomes in patients with congestive heart failure: a retrospective cohort study

Background — Telemedicine use has become widespread due to the COVID-19 pandemic, but how this has impacted patient outcomes remain unclear.

Objective — We sought to investigate the effect of telemedicine use on changes in healthcare utilization and clinical outcomes in patients diagnosed with congestive heart failure.

Methods — We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a heart failure diagnosis anytime prior to March 14, 2020. Telemedicine users were propensity score-matched with unexposed users based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups during 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations.

Results — A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male, mean(SD) age 78.9(12.0) years). All patients showed significant reductions in health service use from pre- to post-index visit. There was a greater decline across time in the unexposed group compared to the telemedicine group for CHF admissions (ratio of slopes for high vs low user (95% CI), 1.02 (1.02-1.03)), cardiovascular admissions (1.03 (1.02-1.04)), any-cause admissions (1.03 (1.02-1.04)), any-cause ED visits (1.03 (1.03-1.04)), visits with any cardiologist (1.01 (1.01-1.02)), lab tests (1.02 (1.02-1.03)), diagnostic tests (1.04 (1.03-1.05)), and new prescriptions (1.02 (1.01-1.03)). However, the decline in primary care visit rates was steeper among telemedicine patients than unexposed patients (ratio of slopes (95% CI), 0.99 (0.99-1.00)).

Conclusions — Overall healthcare utilization over time appeared higher among telemedicine users than low or non-users, suggesting that telemedicine was used among patients with the greatest need, or that it allowed patients to have better access and/or continuity of care among those who received it.