Frequency and Predictors of Virtual Visits in Patients With Heart Failure Within a Large Health System: Retrospective Cohort Study
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 i...
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| Vydané v: | Journal of medical Internet research Ročník 27; číslo 2; s. e70414 |
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| Hlavní autori: | , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Canada
Journal of Medical Internet Research
12.08.2025
JMIR Publications |
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| ISSN: | 1438-8871, 1439-4456, 1438-8871 |
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| Abstract | 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. |
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| AbstractList | Background 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. Objective 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. Methods 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. Results 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. Conclusions 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. Abstract BackgroundVirtual 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. ObjectiveThis 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. MethodsWe 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 ResultsA 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, PPP ConclusionsOnly 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. 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.BackgroundVirtual 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.ObjectiveThis 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.MethodsWe 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.ResultsA 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.ConclusionsOnly 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. 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. 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. |
| Audience | Academic |
| Author | Maw, Anna M Bean, Meagan R Allen, Larry A Huebschmann, Amy G Cervantes, Lilia Wright, Garth C Colborn, Kathryn L Houston, Thomas K Glasgow, Russell E Trinkley, Katie E Matlock, Daniel D |
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| References | de Freitas (R8); 9 Silva-Cardoso (R13); 7 Asgari (R23); 12 Lopez de Coca (R5); 12 Tersalvi (R14); 7 Pearson (R26); 61 Rao (R1); 16 Choi (R4); 41 Heidari (R20); 19 Victoria-Castro (R29); 45 R27 Berry (R19); 228 Diamond (R28); 17 White-Williams (R22); 141 Masterson Creber (R3); 16 Lee (R15); 10 Wang (R21); 28 Goldberg (R9); 7 Bhatt (R2); 23 Gorodeski (R10); 26 Lu (R6); 54 Mubarak (R7); 59 Ingram (R11); 2 Walsh (R16); 38 Fang (R25); 25 R18 Harry (R24); 47 Ng (R12); 13 Canepa (R17); 15 Patra (R30); 28 |
| References_xml | – volume: 141 start-page: e841 issue: 22 ident: R22 article-title: Addressing social determinants of health in the care of patients with heart failure: a scientific statement from the American Heart Association publication-title: Circulation doi: 10.1161/CIR.0000000000000767 – volume: 47 start-page: 76 issue: 2 ident: R24 article-title: Physician task load and the risk of burnout among US physicians in a national survey publication-title: Jt Comm J Qual Patient Saf doi: 10.1016/j.jcjq.2020.09.011 – volume: 17 issue: 2 ident: R28 article-title: Access to mobile health interventions among patients hospitalized with heart failure: insights into the digital divide from the CONNECT-HF mHealth substudy publication-title: Circ Heart Fail doi: 10.1161/CIRCHEARTFAILURE.123.011140 – volume: 19 start-page: 180 issue: 1 ident: R20 article-title: Z-code documentation to identify social determinants of health among Medicaid beneficiaries publication-title: Res Social Adm Pharm doi: 10.1016/j.sapharm.2022.10.010 – volume: 10 ident: R15 article-title: Virtual healthcare solutions in heart failure: a literature review publication-title: Front Cardiovasc Med doi: 10.3389/fcvm.2023.1231000 – volume: 7 ident: R13 article-title: The future of telemedicine in the management of heart failure patients publication-title: Card Fail Rev doi: 10.15420/cfr.2020.32 – volume: 2 start-page: 1 issue: 154 ident: R11 publication-title: Vital Health Stat 2 – volume: 25 start-page: 1995 issue: 12 ident: R25 article-title: Natural language processing for automated classification of qualitative data from interviews of patients with cancer publication-title: Value Health doi: 10.1016/j.jval.2022.06.004 – volume: 61 start-page: 49 issue: 1 ident: R26 article-title: Geospatial analysis of patients’ social determinants of health for health systems science and disparity research publication-title: Int Anesthesiol Clin doi: 10.1097/AIA.0000000000000389 – volume: 41 start-page: 1348 issue: 5 ident: R4 article-title: Urban/rural digital divide exists in older adults: does it vary by racial/ethnic groups? publication-title: J Appl Gerontol doi: 10.1177/07334648211073605 – volume: 228 ident: R19 article-title: Z-codes: an underutilized strategy to identify social determinants of health (SDOH), eliminate health disparities, and achieve health equity publication-title: Am J Surg doi: 10.1016/j.amjsurg.2023.10.037 – volume: 7 ident: R14 article-title: Telemedicine in heart failure during COVID-19: a step into the future publication-title: Front Cardiovasc Med doi: 10.3389/fcvm.2020.612818 – volume: 16 issue: 2 ident: R1 article-title: In-hospital virtual peer-to-peer consultation to increase guideline-directed medical therapy for heart failure: a pilot randomized trial publication-title: Circ Heart Fail doi: 10.1161/CIRCHEARTFAILURE.122.010158 – volume: 28 start-page: 2716 issue: 12 ident: R30 article-title: Extracting social determinants of health from electronic health records using natural language processing: a systematic review publication-title: J Am Med Inform Assoc doi: 10.1093/jamia/ocab170 – ident: R18 – volume: 15 issue: 8 ident: R17 article-title: Temporal trends of heart failure hospitalizations in cardiology versus noncardiology wards according to ejection fraction: 16-year data from the SwedeHF registry publication-title: Circ Heart Fail doi: 10.1161/CIRCHEARTFAILURE.121.009462 – volume: 23 start-page: 1191 issue: 7 ident: R2 article-title: Virtual optimization of guideline-directed medical therapy in hospitalized patients with heart failure with reduced ejection fraction: the IMPLEMENT-HF pilot study publication-title: Eur J Heart Fail doi: 10.1002/ejhf.2163 – volume: 45 start-page: 839 issue: 8 ident: R29 article-title: Pragmatic randomized trial assessing the impact of digital health technology on quality of life in patients with heart failure: design, rationale and implementation publication-title: Clin Cardiol doi: 10.1002/clc.23848 – volume: 38 start-page: 2130 issue: 9 ident: R16 article-title: Incorporating TechQuity in virtual care within the veterans health administration: identifying future research and operations priorities publication-title: J Gen Intern Med doi: 10.1007/s11606-023-08029-2 – volume: 12 issue: 8 ident: R5 article-title: Bridging the generational digital divide in the healthcare environment publication-title: J Pers Med doi: 10.3390/jpm12081214 – volume: 7 issue: 1 ident: R9 article-title: UCHealth’s virtual health center: how Colorado’s largest health system creates and integrates technology into patient care publication-title: NPJ Digit Med doi: 10.1038/s41746-024-01184-8 – volume: 54 ident: R6 article-title: Digital exclusion and functional dependence in older people: findings from five longitudinal cohort studies publication-title: EClinicalMedicine doi: 10.1016/j.eclinm.2022.101708 – volume: 28 start-page: 2608 issue: 12 ident: R21 article-title: Documentation and review of social determinants of health data in the EHR: measures and associated insights publication-title: J Am Med Inform Assoc doi: 10.1093/jamia/ocab194 – volume: 12 ident: R23 article-title: Impact of electronic health record use on cognitive load and burnout among clinicians: narrative review publication-title: JMIR Med Inform doi: 10.2196/55499 – volume: 59 ident: R7 article-title: Elderly forgotten? digital exclusion in the information age and the rising grey digital divide publication-title: Inquiry doi: 10.1177/00469580221096272 – ident: R27 – volume: 26 start-page: 448 issue: 6 ident: R10 article-title: Virtual visits for care of patients with heart failure in the era of COVID-19: a statement from the heart failure society of America publication-title: J Card Fail doi: 10.1016/j.cardfail.2020.04.008 – volume: 13 ident: R12 article-title: Validating the Social Vulnerability Index for alternative geographies in the United States to explore trends in social determinants of health over time and geographic location publication-title: Front Public Health doi: 10.3389/fpubh.2025.1547946 – volume: 16 issue: 11 ident: R3 article-title: Telehealth and health equity in older adults with heart failure: a scientific statement from the American Heart Association publication-title: Circ Cardiovasc Qual Outcomes doi: 10.1161/HCQ.0000000000000123 – volume: 9 start-page: 101 issue: 2 ident: R8 article-title: Heart failure in the elderly publication-title: J Geriatr Cardiol doi: 10.3724/SP.J.1263.2011.12295 |
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| Title | Frequency and Predictors of Virtual Visits in Patients With Heart Failure Within a Large Health System: Retrospective Cohort Study |
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