Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic.
<h4>Background</h4>The mortality risk associated with loss of in-person outpatient visits or transition to virtual care in patients with heart failure (HF) during the COVID-19 pandemic is unknown.<h4>Objectives</h4>Assess changes in outpatient HF care patterns and associated...
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Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0323308 |
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| author | Shilpa Vijayakumar Emily Corneau Sebhat Erqou Aravind Kokkirala Wen-Chih Wu |
| author_facet | Shilpa Vijayakumar Emily Corneau Sebhat Erqou Aravind Kokkirala Wen-Chih Wu |
| author_sort | Shilpa Vijayakumar |
| collection | DOAJ |
| description | <h4>Background</h4>The mortality risk associated with loss of in-person outpatient visits or transition to virtual care in patients with heart failure (HF) during the COVID-19 pandemic is unknown.<h4>Objectives</h4>Assess changes in outpatient HF care patterns and associated mortality.<h4>Methods</h4>Retrospective analysis of HF patients using national Veterans-Health-Administration (VHA) data. Among 509,511 HF patients who received VHA care, we compared mean monthly days-with-an-outpatient-visit from 2/2018-1/2020 (pre-COVID) versus 2/2020-1/2021 (COVID) using T-tests. In a subset of 321,439 patients with ≥1 VHA cardiology or primary-care visit in 2019, we related the presence and type of outpatient visit with mortality using Cox-Regression estimated hazard-ratios (HRs).<h4>Results</h4>Despite a 2-3-fold increase in video-only visits and use of telephone visits to maintain access, the overall days with outpatient visits decreased from a monthly-average of 81.4 ± 6.1 in 2018-2019 and 81.0 ± 5.6 in 2019-2020, to 57.8 ± 11 days in 2020-2021 (P < 0.01 for both), per 100 Veterans. When compared to patients with no-visits during the study period, the adjusted-mortality risk was lowest for patients with at least one in-person (HR 0.42, 95%CI: 0.41-0.44), followed by video-only (HR 0.52, 95%CI: 0.50-0.55) and then telephone-only (HR 0.57, 95%CI: 0.54-0.60) visits (p = 0.14 for trend). Results remained similar when the analysis was repeated (without including telephone visits) for pre-COVID (2/2018-1/2020) periods.<h4>Conclusions</h4>Despite an increase in video and use of telephone visits during the COVID-19 pandemic, there was still a decrease in total outpatient visits for patients with HF. The presence and type of outpatient encounter was associated with the adjusted risk of mortality. |
| format | Article |
| id | doaj-art-b7630b5d62624e6e87bbfbb597955767 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-b7630b5d62624e6e87bbfbb5979557672025-08-20T03:13:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01205e032330810.1371/journal.pone.0323308Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic.Shilpa VijayakumarEmily CorneauSebhat ErqouAravind KokkiralaWen-Chih Wu<h4>Background</h4>The mortality risk associated with loss of in-person outpatient visits or transition to virtual care in patients with heart failure (HF) during the COVID-19 pandemic is unknown.<h4>Objectives</h4>Assess changes in outpatient HF care patterns and associated mortality.<h4>Methods</h4>Retrospective analysis of HF patients using national Veterans-Health-Administration (VHA) data. Among 509,511 HF patients who received VHA care, we compared mean monthly days-with-an-outpatient-visit from 2/2018-1/2020 (pre-COVID) versus 2/2020-1/2021 (COVID) using T-tests. In a subset of 321,439 patients with ≥1 VHA cardiology or primary-care visit in 2019, we related the presence and type of outpatient visit with mortality using Cox-Regression estimated hazard-ratios (HRs).<h4>Results</h4>Despite a 2-3-fold increase in video-only visits and use of telephone visits to maintain access, the overall days with outpatient visits decreased from a monthly-average of 81.4 ± 6.1 in 2018-2019 and 81.0 ± 5.6 in 2019-2020, to 57.8 ± 11 days in 2020-2021 (P < 0.01 for both), per 100 Veterans. When compared to patients with no-visits during the study period, the adjusted-mortality risk was lowest for patients with at least one in-person (HR 0.42, 95%CI: 0.41-0.44), followed by video-only (HR 0.52, 95%CI: 0.50-0.55) and then telephone-only (HR 0.57, 95%CI: 0.54-0.60) visits (p = 0.14 for trend). Results remained similar when the analysis was repeated (without including telephone visits) for pre-COVID (2/2018-1/2020) periods.<h4>Conclusions</h4>Despite an increase in video and use of telephone visits during the COVID-19 pandemic, there was still a decrease in total outpatient visits for patients with HF. The presence and type of outpatient encounter was associated with the adjusted risk of mortality.https://doi.org/10.1371/journal.pone.0323308 |
| spellingShingle | Shilpa Vijayakumar Emily Corneau Sebhat Erqou Aravind Kokkirala Wen-Chih Wu Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. PLoS ONE |
| title | Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. |
| title_full | Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. |
| title_fullStr | Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. |
| title_full_unstemmed | Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. |
| title_short | Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 pandemic. |
| title_sort | outpatient care changes and associated mortality among veterans with heart failure during the covid 19 pandemic |
| url | https://doi.org/10.1371/journal.pone.0323308 |
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