Reply: Telehealth: The Future of Consultations?

We thank Drs Ganeshalingham and Ahmad for their interest in our recent study exploring the role of telehealth in the management of outpatients with heart failure at our health system during the early phase of the COVID-19 pandemic. Our findings showed that the use of telehealth was not associated with increased subsequent emergency department visits, hospitalizations, or mortality in comparison with in-person visits. Now 2 years into the pandemic, telehealth has continued to provide a safe, reliable method to maintain continuity of care, especially as providers and patients became more experienced and comfortable using telehealth.

We agree that patient preference is one of the key factors to improve the telehealth experience. Although some patients prefer—and some chief complaints require—in-person consultation, there remains general satisfaction with telehealth visits. An abstract by Cho et al reported favorable levels of satisfaction in 1,038 patients who were surveyed on their experience during the COVID-19 pandemic. Higher satisfaction scores were noted among patients with longer travel time or need to arrange child care and those who were younger, female, of non-White ethnicity, and who had familiarity with technology.

We also agree with the authors that video visits should be the preferred mode of virtual visit. Our group has reported that socioeconomic disparities were present among patients with heart failure that resulted in less access to video telehealth visits including patients who were older, Black, without spouses or significant others, lacking college educations, and those with lower median household incomes. Further, we found that telephone visits were associated with higher rates of subsequent acute care hospital encounters after the index visits, which is consistent with the data presented by Yuan et al; however, we did not find differences in mortality between the 2 telehealth modes.

We believe that telehealth is here to stay, particularly with the continued pressure for remote medical care given the emergence of novel COVID-19 variants. Our data suggest that in-person visits can be supplemented safely with telehealth visits in a hybrid model. We concur that further studies are needed to identify best practices for future implementation of telehealth to improve outcomes and experience for patients.