Maw Anna M, Wright Garth C, Bean Meagan R, Allen Larry A, Matlock Daniel D, Cervantes Lilia, Glasgow Russell E, Huebschmann Amy G, Colborn Kathryn L, Houston Thomas K, Trinkley Katie E
Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, 12605 E 16th Ave, Aurora, CO, 80045, United States, 1 917-246-0702.
Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
J Med Internet Res. 2025 Aug 12;27:e70414. doi: 10.2196/70414.
Virtual care interventions have the potential to improve access to care and serial medication intensification for patients with chronic heart failure with reduced ejection fraction (HFrEF). However, concerns remain that these interventions might unintentionally create or widen existing disparities in care delivery and patient outcomes.
This study aimed to characterize the health care use patterns of patients who have HFrEF, including specialty type and frequency of in-person and virtual visits.
We conducted a retrospective cohort study of patients with HFrEF within a large health system. Inclusion criteria were patients alive with an ejection fraction ≤40% as of September 1, 2021, and at least one virtual or in-person outpatient visit to a primary care or cardiology clinician in the prior year. Descriptive statistics were used to evaluate baseline patient demographics and clinical use data and outcomes. Univariate analyses were performed both with virtual visits as a variable (received or did not receive) using the chi-square test for association and as a discrete outcome using the Wilcoxon rank-sum test to capture potentially important predictor variables that could influence use or frequency of using virtual visits. The primary outcome of interest was the odds of at least one virtual visit during the 1-year evaluation period from 2021 to 2022. Descriptive statistics were used to evaluate baseline patient demographics and care use. A logistic regression model was used to model at least one primary care or cardiology virtual visit.
A total of 8481 patients were included in the analysis. The mean age was 65.9 years (SD 15.1), 5672 (66.9%) patients were male and 6608 (77.9%) patients were non-Hispanic White. The majority of patients had no cardiology (7938/8481, 93.6%) or primary care (7955/8481, 93.8%) virtual visits during the evaluation period. Multivariable logistic regression showed significantly higher odds of having at least one virtual visit for patients with certain digital access-for example, email on file (odds ratio [OR] 9.3, P≤.001), cell phone on file (OR 2.9, P≤.001), and active electronic health record patient portal (OR 2.8, P≤.001)-than those without. Age, race, ethnicity, rurality, and Social Vulnerability Index were not associated with virtual visits.
Only a minority of patients with HFrEF were seen via virtual visits. Patients who regularly used digital technology were more likely to have virtual visits. Patients were more likely to be seen in a cardiology clinic than by a primary care provider. Although there was no evidence of an association between social determinants of health factors like race, ethnicity, or rurality with digital divide indicators, these findings should be interpreted with caution given the limitations of these data. Future studies should aim to replicate the findings of this study and explore ways to enhance the effective and equitable use of virtual visits.
虚拟护理干预有可能改善射血分数降低的慢性心力衰竭（HFrEF）患者获得护理的机会以及连续药物强化治疗。然而，人们仍然担心这些干预措施可能会无意中造成或扩大现有护理提供和患者结局方面的差异。
本研究旨在描述HFrEF患者的医疗保健使用模式，包括专科类型以及面对面就诊和虚拟就诊的频率。
我们在一个大型医疗系统内对HFrEF患者进行了一项回顾性队列研究。纳入标准为截至2021年9月1日存活且射血分数≤40%，并且在前一年至少有一次面对面或虚拟门诊就诊于初级保健或心脏病学临床医生的患者。描述性统计用于评估患者基线人口统计学和临床使用数据及结局。单因素分析中，将虚拟就诊作为变量（接受或未接受）使用卡方检验进行关联性分析，将其作为离散结局使用Wilcoxon秩和检验以获取可能影响虚拟就诊使用或频率的潜在重要预测变量。感兴趣的主要结局是2021年至2022年1年评估期内至少进行一次虚拟就诊的几率。描述性统计用于评估患者基线人口统计学和护理使用情况。使用逻辑回归模型对至少一次初级保健或心脏病学虚拟就诊进行建模。
共有8481名患者纳入分析。平均年龄为65.9岁（标准差15.1），5672名（66.9%）患者为男性，6608名（77.9%）患者为非西班牙裔白人。在评估期内，大多数患者没有进行心脏病学（7938/8481，93.6%）或初级保健（7955/8481，93.8%）虚拟就诊。多变量逻辑回归显示某些具有数字接入条件的患者进行至少一次虚拟就诊的几率显著更高，例如有存档电子邮件（比值比[OR]9.3，P≤0.001）、有存档手机（OR 2.9，P≤0.001）以及有活跃的电子健康记录患者门户（OR 2.8，P≤0.001）的患者比没有这些条件的患者几率更高。年龄、种族、民族、农村地区和社会脆弱性指数与虚拟就诊无关。
只有少数HFrEF患者通过虚拟就诊接受诊疗。经常使用数字技术的患者更有可能进行虚拟就诊。患者在心脏病学诊所就诊的可能性高于初级保健提供者。尽管没有证据表明种族、民族或农村地区等健康因素的社会决定因素与数字鸿沟指标之间存在关联，但鉴于这些数据的局限性，对这些发现应谨慎解读。未来的研究应旨在重复本研究的结果，并探索增强虚拟就诊有效和公平使用的方法。
