New information regarding COVID-19 continues to emerge daily. This content was based on the sources available at the time of writing.

By Sarah Handzel, BSN, RN

When COVID-19 emerged as a global health crisis, many healthcare entities turned to telehealth as a way to continue patient care without increasing exposure risk. According to the Centers for Disease Control and Prevention, slightly over 30% of weekly health center visits occurred via telehealth between late June and early November 2020.¹

Telehealth and cardiology already have some history. In fact, remote collection of ECG data and subsequent interpretation by physicians in clinical settings were among the first uses of telehealth technologies. Now, as technology continues to improve, telecardiology is helping providers assess and monitor the health and treatment compliance of their patients remotely.

But while telehealth provides distinct benefits for patients and clinicians alike, it's unlikely this approach to patient care will fully replace in-person doctor's visits. Instead, cardiologists can expect a hybrid model of care that uses telehealth to supplement traditional medical care.

Telehealth Trends During COVID-19

Since the onset of the pandemic, cardiologists have been called upon to find ways to support and manage patients with cardiovascular disease remotely. Social distancing guidelines presented a unique challenge to patient care delivery and were a catalyst for the adoption of telehealth by many cardiologists and their patients.

The American College of Cardiology describes telehealth as the ability to conduct patient consultations in real time using audio or video communication technologies.² This often involves the use of other remote health management techniques, such as telemonitoring, as well. Technologies that support telemonitoring include wearable and implanted devices, videoconferencing applications, and a variety of mobile devices, such as smartphones.

While it's clear that telehealth in cardiology increased as a result of the pandemic, it hasn't always been clear which patients are using telehealth for their medical needs. Research from JAMA Network Open analyzed data from over 87,000 pre-COVID in-person visits, over 74,000 in-person COVID-era in-person visits, 4,720 COVID-era video visits, and 10,381 COVID-era telephone visits.³ The data showed that people using telehealth for management of cardiovascular disease were more likely to:

Be younger in age
Be people of color
Have private insurance
Have comorbidities such as hypertension or heart failure

As telehealth becomes a more important aspect of modern patient care models, providers must explore ways of integrating more healthcare consumers into this new standard of care. Understanding the benefits of telehealth may help more patients accept and adapt to it as a component of their care.

Telehealth and Cardiology: Patient Care

Pairing telehealth and cardiology can offer specific advantages to patients and providers alike. For healthcare consumers, the ability to visit with a provider remotely can mean less time away from work, less time spent traveling to and from a doctor's office, and lower costs for the same quality of care. In addition, research in JMIR Cardio found that patients appreciate the increased comfort and lower risk of exposure to COVID-19 that telehealth offers.⁴

Cardiology patients also stand to benefit from telehealth technologies such as wearable ECG monitoring devices. The Pew Research Center notes that, in early 2020, about one in five Americans were already wearing a smart watch or fitness tracker.⁵ Many of these technologies measure heart rate and rhythm using ECG sensors. Smart watches often feature single-lead ECGs, which can be useful for detecting some common arrhythmias such as Afib. However, these technologies are not yet a replacement for conventional 12-lead ECG. A study in Nature Reviews Cardiology shows that several smart watches or wrist-worn monitors compare favorably with standard ECG, though a chest strap was the most similar.⁶ How this data should be handled is still a matter of debate.

Telehealth also offers advantages for cardiologists. According to the Rural Health Information Hub, in many cases, telehealth improves patient engagement, which in turn can improve healthcare quality.⁷ Because telehealth visits are typically less time-consuming, this method of patient care can also help reduce overhead and increase a practice's revenue and efficiency.

Additionally, telehealth makes it possible to reach more patients than ever before. Expanding access to healthcare is a chief goal of the U.S. Department of Health and Human Services Healthy People 2030 campaign, along with reducing healthcare costs and improving insurance coverage.⁸ The agency anticipates that telehealth will help improve access to a variety of health services for millions of Americans within the next ten years.

Stay on top of cardiology trends and best practices by browsing our Diagnostic ECG Clinical Insights Center.

Selecting Appropriate Patients for Telehealth Success

Some patients may benefit from telehealth more than others. According to the American College of Cardiology, elderly individuals may find it difficult to use and adapt to telehealth technologies, which could impact the quality of care they receive. Telehealth also may not be appropriate for cardiology patients who are acutely ill or have complex medical conditions in addition to cardiovascular disease.

An article in Medical Economics reports that 83% of all patients expect to continue using telehealth after the pandemic subsides.⁹ The combination of telehealth and cardiology offers a unique opportunity to provide high-quality patient care, protect individuals, increase access to care, and improve patient outcomes. Telehealth is here to stay, and healthcare providers must work to adapt to it.

Sarah Handzel, BSN, RN has been writing professionally since 2016 after spending over nine years in clinical practice in various specialties.

The opinions, beliefs and viewpoints expressed in this article are solely those of the author and do not necessarily reflect the opinions, beliefs and viewpoints of GE Healthcare. The author is a paid consultant for GE Healthcare and was compensated for creation of this article.

References:

Demeke H B et al. Trends in use of telehealth among health centers during the COVID-19 Pandemic — United States, June 26 - November 6, 2020. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Feb 2021; vol. 70 (iss. 7): 242-244. https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a3.htm
Xiaoming J MD and Kohli P MD. American College of Cardiology, Expert Analysis. Telehealth and Cardiovascular Disease Prevention: A Discussion of the Why and the How. https://www.acc.org/latest-in-cardiology/articles/2020/09/15/14/14/telehealth-and-cardiovascular-disease-prevention
Yuan N et al. Patient use and clinical practice patterns of remote cardiology clinic visits in the era of COVID-19. Journal of the American Medical Association. Apr 2021; vol. 4 (iss. 4). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778152?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=040521
Singh A, MD et al. Patient perspectives with telehealth visits in cardiology during COVID-19: Online patient survey study. Journal of Medical Internet Research Cardio. Jan 2021; vol. 5 (iss. 1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834614/
Vogels E. About on-in-five Americans use a smart watch or fitness tracker. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/01/09/about-one-in-five-americans-use-a-smart-watch-or-fitness-tracker/
Bayoumy K et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nature Reviews Cardiology. Mar 2021; vol. 18: 581-599. https://www.nature.com/articles/s41569-021-00522-7
Rural Health Information Hub. Telehealth Models for Increasing Access to and Engagement with Care Outside of Healthcare Settings. https://www.ruralhealthinfo.org/toolkits/telehealth/2/care-delivery/nontraditional-settings
U.S. Department of Health and Human Services. Health Care. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care
Zimiles A. Four new statistics that prove that telemedicine isn't just a pandemic fad. Medical Economics. https://www.medicaleconomics.com/view/four-new-statistics-that-prove-that-telemedicine-isn-t-just-a-pandemic-fad