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. 2023 Apr 1:192:174-181.
doi: 10.1016/j.amjcard.2023.01.028. Epub 2023 Feb 20.

An Analysis of Telehealth in the Outpatient Management of Atrial Fibrillation During the COVID-19 Pandemic

Islam Shatla  1 , Rayan S El-Zein  2 , Aamer Ubaid  1 , Ahmed ElBallat  1 , Yasser Sammour  1 , Kevin F Kennedy  3 , Kayla Barta  3 , Tara Brand-Moody  3 , Faith Cordle  3 , LeAndrea Williams  3 , Michael Giocondo  2 , Sanjaya Gupta  2 , Brian Ramza  2 , Daniel Steinhaus  2 , Omair Yousuf  2 , John A Spertus  2 , Alan P Wimmer  4
Affiliations

An Analysis of Telehealth in the Outpatient Management of Atrial Fibrillation During the COVID-19 Pandemic

Islam Shatla et al. Am J Cardiol. .

Abstract

The COVID-19 pandemic accelerated adaption of a telehealth care model. We studied the impact of telehealth on the management of atrial fibrillation (AF) by electrophysiology providers in a large, multisite clinic. Clinical outcomes, quality metrics, and indicators of clinical activity for patients with AF during the 10-week period of March 22, 2020 to May 30, 2020 were compared with those from the 10-week period of March 24, 2019 to June 1, 2019. There were 1946 unique patient visits for AF (1,040 in 2020 and 906 in 2019). During 120 days after each encounter, there was no difference in hospital admissions (11.7% vs 13.5%, p = 0.25) or emergency department visits (10.4% vs 12.5%, p = 0.15) in 2020 compared with 2019. There was a total of 31 deaths within 120 days, with similar rates in 2020 and 2019 (1.8% vs 1.3%, p = 0.38). There was no significant difference in quality metrics. The following clinical activities occurred less frequently in 2020 than in 2019: offering escalation of rhythm control (16.3% vs 23.3%, p <0.001), ambulatory monitoring (29.7% vs 51.7%, p <0.001), and electrocardiogram review for patients on antiarrhythmic drug therapy (22.1% vs 90.2%, p <0.001). Discussions about risk factor modification were more frequent in 2020 compared with 2019 (87.9% vs 74.8%, p <0.001). In conclusion, the use of telehealth in the outpatient management of AF was associated with similar clinical outcomes and quality metrics but differences in clinical activity compared with traditional ambulatory encounters. Longer-term outcomes warrant further investigation.

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Conflict of interest statement

Disclosures The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Proportion of in-person visits and telehealth visits by year.
Figure 2
Figure 2
Proportion of visits by provider type. APP = advanced practice provider.
Figure 3
Figure 3
Multivariate analysis of clinical outcomes and indicators of clinical activity in 2020 versus 2019. AAD = AAD = antiarrhythmic drug.
Figure 4
Figure 4
Outcomes according to year, showing causes of hospital admission (A) and all-cause mortality (B).
See this image and copyright information in PMC

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