Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic

Brown, Kemar J; Mathenge, Njambi; Crousillat, Daniela; Pagliaro, Jaclyn; Grady, Connor; Katz, Nava; Singh, Jagmeet P; Bhatt, Ami B

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. OBJECTIVES: To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. METHODS: In this single centre retrospective study, all ambulatory cardiovascular encounters occurring between March 16(th) - June 19(th), 2020 were assessed. Baseline characteristics by visit type (in-person, TM-phone, TM-video) were compared using Chi-square and student t-tests, with statistical significance defined by p value < 0.05. Multivariate logistic regression was used to explore the predictors of TM versus in-person care. RESULTS: 8446 patients (86% Non-Hispanic White, 42% female, median age 66.8 +/- 15.2 years) completed an ambulatory cardiovascular visit during the study period. TM-phone (n = 4,981, 61.5%) was the primary mode of ambulatory care followed by TM-video (n = 2693, 33.2%). Non-Hispanic Black race (OR 0.56; 95% CI: 0.35 - 0.94, p-value=0.02), Hispanic ethnicity (OR 0.53; 95% CI: 0.29 - 0.98, p = 0.04), public insurance (Medicaid OR 0.50; 95% CI:0.32 – 0.79, p = 0.003, Medicare OR 0.65; 95% CI: 0.47– 0.89, p = 0.009), zip-code linked median household income (MHI) of <$75,000, age >85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM-video encounters and a higher likelihood of in-person care. CONCLUSIONS: Significant disparities in TM-video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups.