Longer-Term Results of a Clinician-to-Clinician e-Consult Program in Patients with Heart Failure: Implications for Heart Failure Clinical Management.

To compare the health outcomes, specifically hospitalization and mortality rates, of primary care physicians' referrals to the cardiology department for ambulatory assistance in heart failure (HF) over three clearly defined periods: before, during the electronic consultation program implementation (e-consult), and during the COVID-19 pandemic. Between 2010 and 2021, 6,859 HF patients were referred at least once. Of these, 4,851 received e-consultations, and 2,008 underwent single-act consultations. A time series regression model was used to analyze the impact of e-consult implementation (started in 2013) on all-cause, cardiovascular (CV), and HF-related hospital admissions and mortality rates. e-Consults reduced the waiting time for cardiology care to 9 days. Hospital admissions decreased significantly after the implementation of e-consult (relative risk incidence [RRi] [95% confidence interval {CI95%}]: 0.867 [0.875-0.838] for HF, 0.838 [0.825-0.856] for cardiovascular disease, and 0.639 [0.635-0.651] for all-cause diseases), and mortality decreased (RRi [CI95%]: 0.981 [0.977-0.983] for HF, 0.977 [0.970-0.980] for CV, and 0.985 [0.984-0.985] for all causes). These improvements persisted during the COVID-19 pandemic. The implementation of the e-consult program for managing HF patient referrals resulted in reduced waiting times for cardiology care and decreases in hospitalizations and mortality rates. These benefits were maintained during the COVID-19 pandemic.