Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: A Retrospective Cohort Study

JMIR Cardio. 2022 Nov 13. doi: 10.2196/39566. Online ahead of print.

ABSTRACT

BACKGROUND: Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, post-hospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in post-hospitalization follow-up or heart failure readmissions.

OBJECTIVE: To determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in ADHF follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations.

METHODS: This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15-June 1, 2020) compared to the same timeframe in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and ICU admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed.

RESULTS: From March 15, 2019 to June 1, 2020, there were 1,162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020 compared with 2019 (442 vs 720; P < .001). Patients in 2020 had higher rates of ICU admission compared to 2019 (15.8% vs 11.1%; P = .02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P = .02). While there was a trend towards higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P = .17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P < .001). Inequities in 7-day follow-up for Non-Hispanic Black patients compared to Non-Hispanic White patients decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P = .03).

CONCLUSIONS: There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up.

PMID:36409959 | DOI:10.2196/39566