Abstract 15664: In-Person Outpatient Care Delays, Virtual Clinic Visits and Associated Mortality Among Veterans With Heart Failure During the Covid-19 Pandemic

Abstract

Background: The impact of care delays and outcome among HF patients during the COVID-19 pandemic and role of virtual video or telephone visits has not been well studied. We studied changes in outpatient care patterns and associated mortality among HF patients during the pandemic. Methods: Retrospective analysis of HF patients using Veterans Affairs data, with exposure period 2/2020-9/2020 and outcome period 10/2020-4/2021. Veterans were diagnosed with HF prior to 2/2020 and had at least 1 cardiology/primary care visit in 2019. We compared volume/type of outpatient visit (in-person, virtual video, telephone, none) and yearly mortality rates 2 years before and 1 year after 2/2020. We related type of outpatient encounter to mortality during the outcome period. Hazard ratios and 95% confidence intervals were estimated using multivariable Cox-models adjusted for potential confounders. Results: 290,789 Veterans with HF were included, with mean age 73 years, 96% male. Compared to the prior 2 years, in-person encounter days were lower (224.3/100 in 2018, 2019 vs 180.4/100 after 2/2020 P<0.01), while video encounter days increased (3.4/100 in 2018, 2019 vs 9.8/100 after 2/2020 P<0.01). Mortality rates were 12.7/1000 in 2018, 2019 and 12.9/1000 after 2/2020 P<0.01. Compared to those with no outpatient visits after 2/2020, mortality risk was lowest for Veterans with at least one in-person visit (HR 0.66, 95% CI 0.61-0.71), followed by video-only (HR 0.71, 95% CI 0.66-0.77) and lastly by telephone-only (HR 0.78, 95% CI 0.71-0.86) (Figure 1). Conclusions: During the COVID-19 pandemic, a decrease in outpatient visits and increase in mortality was seen among Veterans with HF compared to prior years. Veterans engaged in any outpatient care (evidenced by visits) had lower mortality compared to those with none. Patients with in-person visits had slightly lower mortality risk than those with virtual video only visits, whom had lower mortality risk than those with telephone-only visits.