Longer-Term Results of a Clinician-to-Clinician e-Consult Program in Patients with Heart Failure: Implications for Heart Failure Clinical Management.

Abstract

Objectives: To compare the health outcomes, specifically hospitalization and mortality rates, of primary care physicians' referrals to the cardiology department for ambulatory assistance in heart failure (HF) over three clearly defined periods: before, during the electronic consultation program implementation (e-consult), and during the COVID-19 pandemic. Methods: Between 2010 and 2021, 6,859 HF patients were referred at least once. Of these, 4,851 received e-consultations, and 2,008 underwent single-act consultations. A time series regression model was used to analyze the impact of e-consult implementation (started in 2013) on all-cause, cardiovascular (CV), and HF-related hospital admissions and mortality rates. Results: e-Consults reduced the waiting time for cardiology care to 9 days. Hospital admissions decreased significantly after the implementation of e-consult (relative risk incidence [RRi] [95% confidence interval {CI95%}]: 0.867 [0.875-0.838] for HF, 0.838 [0.825-0.856] for cardiovascular disease, and 0.639 [0.635-0.651] for all-cause diseases), and mortality decreased (RRi [CI95%]: 0.981 [0.977-0.983] for HF, 0.977 [0.970-0.980] for CV, and 0.985 [0.984-0.985] for all causes). These improvements persisted during the COVID-19 pandemic. Conclusions: The implementation of the e-consult program for managing HF patient referrals resulted in reduced waiting times for cardiology care and decreases in hospitalizations and mortality rates. These benefits were maintained during the COVID-19 pandemic.