Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care

Version 1 : Received: 12 May 2023 / Approved: 15 May 2023 / Online: 15 May 2023 (15:30:16 CEST)

How to cite: García-Vega, D.; Mazon-Ramos, P.; Portela-Romero, M.; Rodríguez-Mañero, M.; Rey-Aldana, D.; Sestayo-Fernandez, M.; Cinza-Sanjurjo, S.; González-Juanatey, J.R. Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care. Preprints 2023, 2023051056. https://doi.org/10.20944/preprints202305.1056.v1 García-Vega, D.; Mazon-Ramos, P.; Portela-Romero, M.; Rodríguez-Mañero, M.; Rey-Aldana, D.; Sestayo-Fernandez, M.; Cinza-Sanjurjo, S.; González-Juanatey, J.R. Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care. Preprints 2023, 2023051056. https://doi.org/10.20944/preprints202305.1056.v1

Abstract

(1) Objectives. Patients with heart failure (HF) who experience hospitalizations for worsening HF (HFH) are at high risk of subsequent events. We aimed to evaluate the impact of an outpatient care management program that includes a clinician-to-clinician e-consultation using an integrated electronic medical record in a healthcare area with a widely dispersed population on delay time in care, hospital admissions, and mortality in a high-risk group of patients with HF and previous episodes of HFH. (2) Methods. We selected 6,444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4,851 were attended in e-consult, and 2,008 in one-time in-person consultations. In 2,230 HF patients, there was documentation of a previous episode of HFH. Using an interrupted time series regression model, we analysed the impact of incorporating e-consult into the health care model in the group of patients with HFH and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). (3) Results. In the group of patients with previous HF hospitalizations, the introduction of e-consult substantially decreased waiting times to cardiology care. The time elapsed to care after e-consult implementation was significantly reduced compared with the previous in-person period (8.6 [8.7] vs 55.4 [79.9] days, p<0.001). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [CI95%]: 0,837 [0,840-0,833]), 0,900 [0,862-0,949] for CV and 0,699 [0,678-0,726] for all-cause hospitalizations. There was also lower mortality (iRR [CI95%]: 0.715 [0.657-0.798] due to HF, 0,737 [0.764-0.706] for CV and 0,687 [0.652-0,718] for all-cause). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH and were independent of the patient’s clinical characteristics managed during the in-person or e-consultation periods. (4) Conclusions. In HF patients with previous HFH, an outpatient care program that includes an e-consult significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.

Keywords

heart failure; hospitalization; cardiovascular outcomes; electronic consultation

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

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