Introduction

The 2022 ACC/AHA/HFSA guidelines recommend integration of palliative care (PC) in heart failure (HF) management. Despite these recommendations, palliative care (PC) utilization remains suboptimal. It remains unclear how the evolution of telemedicine during the COVID-19 pandemic impacted PC delivery for the HF population. We sought to evaluate trends in telemedicine and in-person PC visits in the HF population during the COVID-19 pandemic.

Hypothesis

We hypothesize that there was a rise in PC telemedicine utilization for the HF population during the COVID-19 pandemic.

Methods

Retrospective cross-sectional observational analysis of 73,074 patients with HF admitted between 2017 and 2022. Patients were divided into two cohorts (Cohort A and B) pre-COVID-19 era (2017-2019) (A) and post-COVID-19 era (January 2020-2022) (B). Demographic variables including age, race, sex, income, proximity to tertiary care center (TCC), and insurance types are presented as a percentage derived by the Chi-squared test, and numerical variables Charlson comorbidity index (CCI), ceased to breathe (CTB) are presented as mean and standard deviation derived by the t-test.

Results

PCC utilization decreased from 4.01% in 2019 to 0.87% in 2022. We saw a general rise in tele-PCC utilization during the pandemic, with peak utilization of 1.42% in 2020 compared to 0% in 2017, with a decline to 0.98 % in 2022 (Figure.1). For Tele PCC utilization between the two cohorts (A and B) we saw a rise in utilization most notably in elderly (age >75 years) (1 (3.45%) vs 37 (14.68%)), white population (18 (62.07%) vs 189 (75.00%)), proximity to TCC (<10 miles) (11 (37.93%) vs 113 (44.84%)), low-income households (<50K) (13 (44.83%) vs 134 (53.17%)). For PCC utilization, between the two cohorts (A and B) we saw utilization was higher in the middle age group (age >50 and <75 years) (327 (22.95%) vs 196 (28.99%)), high income group (> 100K) (67 (4.70%) vs 34 (5.03%)) and those farther from TCC (>20 miles) (111 (7.79%) vs 62 (9.17%)).

Conclusions

There was a rise in utilization of tele PCC in HF patients over time from 2017-2022. Perhaps, telemedicine may serve as a successful tool in future to eliminate the gap that exists in PCC utilization in HF patients, however, warrants further study.

中文翻译：

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Covid-19 大流行和远程医疗的扩展对入院心力衰竭患者姑息治疗利用的影响

介绍

2022 年 ACC/AHA/HFSA 指南建议将姑息治疗 (PC) 纳入心力衰竭 (HF) 管理中。尽管有这些建议，姑息治疗 (PC) 的利用率仍然不理想。目前尚不清楚 COVID-19 大流行期间远程医疗的演变如何影响心力衰竭人群的 PC 交付。我们试图评估 COVID-19 大流行期间心力衰竭人群的远程医疗和亲自 PC 就诊的趋势。

假设

我们假设在 COVID-19 大流行期间，心力衰竭人群的 PC 远程医疗使用率有所增加。

方法

对 2017 年至 2022 年期间入院的 73,074 名心力衰竭患者进行回顾性横断面观察分析。患者被分为两个队列（队列 A 和 B）：COVID-19 时代之前（2017-2019）（A）和 COVID-19 时代之后（2020 年 1 月-2022 年）(B)。人口统计变量包括年龄、种族、性别、收入、与三级护理中心 (TCC) 的距离和保险类型，以卡方检验得出的百分比形式呈现，数值变量查尔森合并症指数 (CCI)、停止呼吸 ( CTB) 表示为通过 t 检验得出的平均值和标准差。

结果

PCC 利用率从 2019 年的 4.01% 下降到 2022 年的 0.87%。我们看到大流行期间远程 PCC 利用率普遍上升，2020 年峰值利用率为 1.42%，而 2017 年为 0%，2022 年下降至 0.98%。 2022 年（图 1）。对于两个队列（A 和 B）之间的 Tele PCC 使用率，我们发现使用率上升最显着的是老年人（年龄 >75 岁）（1 (3.45%) vs 37 (14.68%)）、白人 (18 (62.07%) ) vs 189 (75.00%))、靠近 TCC (<10 英里) (11 (37.93%) vs 113 (44.84%))、低收入家庭 (<50K) (13 (44.83%) vs 134 (53.17%) ））。对于 PCC 利用率，在两个队列（A 和 B）之间，我们发现中年组（年龄 >50 岁和 <75 岁）的利用率较高（327 人 (22.95%) vs 196 人 (28.99%)）、高收入组（ > 100K) (67 (4.70%) vs 34 (5.03%)) 以及距离 TCC 较远的 (>20 英里) (111 (7.79%) vs 62 (9.17%))。

结论

从 2017 年到 2022 年，心力衰竭患者中远程 PCC 的使用率随着时间的推移有所增加。也许，远程医疗将来可能成为消除心力衰竭患者 PCC 使用方面存在的差距的成功工具，但值得进一步研究。