A recently published scientific statement from the American Heart Association (AHA) states that although there are existing challenges related to technology access, telehealth can effectively provide cardiovascular care as well as reduce costs, improve care quality, and increase access to care.

AHA is a voluntary organization focused on improving heart disease and stroke care. In its scientific statement, published in the AHA’s flagship journal Circulation, the association detailed the impact of telehealth use on the treatment of cardiovascular disease (CVD).

Throughout the COVID-19 pandemic, the use of telehealth has grown tremendously. In mid-2020, up to 30 percent of all US clinic visits occurred virtually.

A group from the AHA studied the relationship between telehealth and treatment for CVD, concluding that virtual care is generally beneficial for CVD patients. But there are various obstacles to care. The report detailed several strategies for overcoming these common barriers.

The benefits of using telehealth to treat CVD include the potential to reduce healthcare expenditures, improve access among those residing in rural areas, and increase the overall quality of care along with patient satisfaction.

Services such as telehealth portals and smart devices are also good options for CVD patients as they allow clinicians to manage conditions remotely at cost-effective rates, according to the AHA.

Despite these benefits, telehealth use has several downsides, which may affect the patient and the provider.

For providers, there are often challenges related to the uptake of telehealth technology, reimbursement issues, maintaining efficient workflow, and the need for IT infrastructure when managing data gathered from technology.

Meanwhile, patients with CVD often face challenges such as a lack of access to technology, particularly affecting those older or under-resourced. Also, they often face health literacy hurdles, such as cultural barriers.

Further, patients may face issues related to insufficient access to internet bandwidth that enables high-quality video during appointments.

To compensate for these issues, the report detailed various strategies that may help remove barriers to CVD care through telehealth, most of which relate to infrastructure, technology, and reimbursement.

For instance, not all insurance payers reimburse equally for in-person, telephone, and video-based appointments. Thus, as telehealth use continues, the AHA recommends that providers assess telehealth quality and research its role post-pandemic.

“Telehealth will play an important role in the future of cardiovascular care because the evolution of technology will enable new remote care opportunities to improve medical accessibility,” said the statement’s lead author Edwin A. Takahashi, MD, an assistant professor of radiology in the division of interventional radiology at the Mayo Clinic College of Medicine, in a press release. “Hopefully, this will have a strong benefit for patients from historically excluded and rural communities who often face health care disparities and are most at risk for cardiovascular diseases.”

The scientific statement follows several studies displaying the benefits telehealth and remote care can offer patients requiring cardiac care.

A study published in November found that a 12-week remote support program improved blood pressure among hypertension patients. Participants in the study received lifestyle guidance from the AHA, and one group received weekly calls from a dietician.

The two groups experienced similar reductions in 24-hour systolic blood pressure during the study period. However, those who received care from a dietician experienced a more significant reduction in systolic blood pressure while asleep.

The study also led researchers to better understand how to improve blood pressure and reduce the risk of CVD.

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New American Heart Association statement finds telehealth is effective for CVD care, however, issues like access to technology hinder widespread adoption

Statement Highlights:

• Telehealth is an effective option for educating, diagnosing, monitoring and following people with health issues including cardiovascular disease.
• Telehealth may reduce health care costs, improve access to care in rural and under-resourced communities, and increase quality of care and patient satisfaction.
• Advances in technology have enabled telehealth’s growth and improved accessibility to routine care.
• While the COVID-19 pandemic improved telehealth’s infrastructure and increased its use, the pandemic also exposed limitations to its use for some people, such as limited resources to afford the technology, lack of internet bandwidth and language differences that may prevent people from using digital platforms to their fullest extent.
• Research into telehealth implementation barriers and addressing those will help ensure equitable, high-quality care for people with cardiovascular disease.

Embargoed until 4 a.m. CT/5 a.m. ET Monday, Nov. 14, 2022

DALLAS, Nov. 14, 2022 — Telehealth is a proven and valuable option for people with cardiovascular disease, however, there are limitations to its use in rural and under-resourced communities, according to a new scientific statement from the American Heart Association, published today in the Association’s flagship peer-reviewed journal Circulation. An American Heart Association scientific statement is an expert analysis of current research and may inform future treatment guidelines.

Telehealth enables remote delivery of health care through technologies, such as structured telephone or video support and remote monitoring of wearable or implantable devices. This kind of technology-driven health care delivery grew tremendously during the COVID-19 pandemic, with up to 30% of all U.S. clinic visits conducted via telehealth in mid-2020—showing interest in and capability of telehealth as a substitute for face-to-face patient care. However, data has shown its use has slowly declined as COVID-19 restrictions eased in late 2021.

“Telehealth is transforming the way health care is delivered by improving convenience and availability,” said the statement’s lead author Edwin A. Takahashi, M.D., an assistant professor of radiology in the division of interventional radiology at the Mayo Clinic College of Medicine in Rochester, Minnesota. “However, we learned during the pandemic when we were forced to limit in-person care that there are limitations to using telehealth.”

This new scientific statement, “An Overview of Telehealth in the Management of Cardiovascular Disease,” highlights the impact of telehealth in heart disease, stroke and peripheral artery disease (PAD) management, reviews strategies and obstacles for telehealth adoption in cardiovascular disease (CVD) care and identifies knowledge gaps.

The benefits of telehealth for CVD

The writing group’s review found that telehealth may:

• reduce health care costs;
• improve access to care in rural and underserved areas; and
• increase care quality and patient satisfaction.

These benefits are especially important for people with CVD, which disproportionately affects people from underrepresented racial and ethnic groups who often have additional barriers to health care and those with less access to medical care.

Telehealth portals and smart devices may be cost-effective options for remotely managing conditions that are cardiac risk factors, such as high blood pressure and diseases like heart failure and coronary artery disease. “Telestroke,” the most studied area of telehealth in CVD, which is highly specialized stroke care delivered by first responders receiving instructions and guidance from remote stroke experts, often leads to improved rehabilitation and recovery for people who have had a stroke or may otherwise lack access to specialized stroke care.

The challenges of using telehealth

Challenges that may prevent more widespread telehealth use in CVD include barriers for both health care professionals and their patients.

For health care professionals, the challenges identified are:

• acceptance and uptake of telehealth technology, which may vary because of health care professionals’ age, technology expertise and perceptions;
• inconsistent reimbursement and licensing matters (license requirements vary by state);
• logistical challenges in scheduling and maintaining workflow; and
• lack of infrastructure to analyze data from remotely monitored devices.

Privacy and security are also key factors for professionals to consider. “Even though most telehealth platforms are highly encrypted,” Takahashi said, “they are not fully secure and may be at risk for data breaches.”

For people with CVD, the challenges identified are:

• limited resources to access technology and devices for older adults and under-resourced populations;
• health literacy barriers, including cultural and language barriers that may prevent people from using digital platforms, consumer wearables and other devices to their full capacity; and
• insufficient access to internet bandwidth for a high-quality video appointment.

The statement asserts that the infrastructure for broadband internet needs to be improved, especially in rural areas that lack direct access to medical care, creating a “medical desert.”

Strategies to overcome obstacles

Infrastructure, technology and reimbursement are the key areas to address barriers to telehealth use. For the approximately 25% of U.S. adults without broadband access, the statement suggests public policy changes may be helpful to supplement efforts by the private sector to expand affordability and access to internet services. An appraisal of current policy and identifying potential targets for policy reform are necessary, according to the writing group.

As the country shifts back to in-person care, the statement encourages research into the role of telehealth beyond the pandemic. “Telehealth has the potential to have a larger role in urgent diagnosis and remote monitoring,” Takahashi said.

However, reimbursement challenges need to be addressed, and simplified, as well. Not all insurance payers reimburse equally for in-person vs. telephone vs. video appointments, which ultimately lowers reimbursement for professionals who care for patients without video capability. And, as telehealth expands, there is a need for standards in how to assess the quality of telehealth care provided.

“Telehealth will play an important role in the future of cardiovascular care because the evolution of technology will enable new remote care opportunities to improve medical accessibility,” Takahashi said. “Hopefully, this will have a strong benefit for patients from historically excluded and rural communities who often face health care disparities and are most at risk for cardiovascular diseases.”

As part of the American Heart Association’s commitment to excellence in telehealth care, the Association acquired the American Board of Telehealth (ABT), a national entity that establishes best practices and standards for telemedicine education. The American Board of Telehealth, powered by the American Heart Association, aims to weave telemedicine into the fabric of health care delivery across the country as a vital tool in promoting access to quality care no matter where you are.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention, the Council on Hypertension, the Council on the Kidney in Cardiovascular Disease, and the Stroke Council. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Lee H. Schwamm, M.D.; Opeolu M. Adeoye, M.D., FAHA; Olamide Alabi, M.D.; Eiman Jahangir, M.D., FAHA; Sanjay Misra, M.D., FAHA; and Carolyn H. Still, Ph.D., M.S.M. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

Additional Resources:

• Available multimedia is on right column of release link https://newsroom.heart.org/news/telehealth-is-a-valuable-option-in-cardiovascular-care-though-challenges-remain
• Spanish news release
• After Nov. 14, view the manuscript online.
• You’re The Cure blog: Protecting Access to Telehealth Services (March 2022)
• AHA News article: Are virtual doctor visits safe for discharged heart failure patients? (July 2020)
• AHA policy statement: Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care (Dec 2016)
• Follow AHA/ASA news on Twitter @HeartNews

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1. 

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A remote patient monitoring program for babies who’ve had heart surgery has helped reduce infant mortality by some 40 percent, according to the American Heart Association.

In a scientific statement published in the latest edition of the Journal of the American Heart Association, researchers found that an interstage home monitoring (IHM) program, which gives parents mHealth tools and instructs them on how to monitor important health parameters including an infant’s oxygen saturation levels, caloric intake and weight gain, played a significant role in improving overall health outcomes.

The program also trained parents to identify certain warning signs, such as respiratory changes, sweating, fussiness, diarrhea, fever or changes in skin color, and notify the care team immediately.

The study, led by Nancy Rudd, MS, CPNP-PC/AC, the nurse coordinator for the IHM program at the Herma Heart Institute at Children’s Wisconsin, found that the telehealth program produced an increase in hospitalizations, but most were for observation or minimal interventions, and there were fewer readmissions for major adverse events.

In addition, the study found that the telehealth platform led to an unexpected 28 percent improvement in infant weight gain – the result, perhaps, of frequent monitoring and the ability to adjust care management plans to optimize nutrition.

“Prior to interstage home monitoring programs, the outpatient management of interstage infants was the same as that of much less complex patients,” Rudd said in an AHA press release. “Unfortunately, the tenuous nature of these infants means they can get very sick very quickly from even minor childhood illness like the common cold.”

Children’s Wisconsin implemented its IHM program in 2000, according to the release, following a study that found mortality rates as high as 16 percent in infants recovering from surgery for heart defects.

Rudd’s research focused on some 50 IHM programs launched between 2008 and 2016.

“IHM is an innovative strategy developed to augment conventional outpatient management and to assist with early detection of physiologic changes associated with morbidity and mortality following successful (surgery),” she concluded in her report. “There is overwhelming evidence of improvement in single ventricle infant survival and growth outcomes with IHM programs.”

“This surveillance strategy has become the standard of care for most pediatric cardiac programs and continues to evolve using telehealth platforms such as phone technology and tablet‐based real‐time video encounters in an effort to optimize data collection and visual assessment of the infant at home,” she added. 

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New guidelines for stroke triage published in the AHA’s Stroke journal call on first responders to use telehealth and mHealth to screen and diagnose patients and ensure speedy transport to the right care facility.

By Eric Wicklund

May 28, 2020 – A team of stroke experts has published new guidelines calling for the increased use of telemedicine during triage and transport to improve patient care and outcomes.

Writing in the American Heart Association’s Stroke journal, the team calls on EMS crews to use connected health technologies to improve care management of stroke victims and speed transport to the facility that best meets the patient’s needs. This is especially vital at a time when treatment may be affected by concerns of coronavirus contamination.

“Now more than ever, during the COVID-19 pandemic, we need to work collaboratively and support our emergency medical services providers working day and night on the front lines for our community,” Andrew Southerland, MD, a stroke expert with the University of Virginia’s Departments of Neurology and Public Health Sciences, said in a release prepared by UVA. “To achieve this, we must optimize communication and prehospital care for patients.”

Along with Southerland, the team consists of Mayank Goyal, MD, and Johanna M. Ospel of the University of Calgary; Charles Wira of Yale University and the Yale Stroke Program; Sepideh Amin-Hanjani of the University of Illinois; Justin Fraser of the University of Kentucky; and Peter Panagos of the Washington University School of Medicine in St. Louis. They wrote the guidance on behalf of the American Stroke Council’s Emergency Neurovascular Care, Telestroke and Neurovascular Intervention Committees.

The report gives added weight to the value of telestroke services in delivering care as quickly as possible to patients suspected of having suffered a stroke. Studies have found that telehealth can shave valuable minutes off of treatment time, enabling care providers to administer intravenous tissue plasminogen activator (tPA) sooner, thereby lessening the chances of permanent brain damage and death.

The guidelines call on EMS crews to use mHealth tools whenever possible to screen patients for COVID-19 symptoms, and have a protocol in place if the patient can’t be screened or if the patient shows signs of infection.

In addition, because patients with the COVID-19 virus are more likely to need a ventilator and intensive care, emergency crews should take into consideration whether a hospital can provide that care. And they should be in contact with those hospitals to ensure timely transport.

“During the COVID-19 pandemic, it is more important than ever to ensure that the patient is transferred to the right hospital the first time around,” the guidelines note.

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