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2023 HSR&D/QUERI National Conference Abstract

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1110 — In-person outpatient care delays, virtual clinic visits and associated mortality among Veterans with heart failure during the COVID-19 pandemic

Lead/Presenter: Wen-Chih Wu,  Providence VAMC
All Authors: Vijayakumar S (Brigham and Women's Hospital), Corneau E (Providence VA Medical Center), Erqou S (Providence VA Medical Center), Kokkirala A (Providence VA Medical Center), Wu W (Providence VA Medical Center)

Objectives:
To determine the relationship between in-person, virtual or no outpatient visits and mortality outcomes of Veterans with HF during the COVID-19 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) 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 180.4/1000 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).

Implications:
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.

Impacts:
For Veterans with HF, delays in outpatient care during the COVID-19 pandemic was associated with increased mortality. Having at least one in-person or purely virtual visit, was associated with significantly lower mortality during in this population during the period, suggesting the potential utility of virtual visits in this setting.