Why We Aren’t Using More Telehealth for the Management of Cardiovascular Disease

Telehealth offers a proven and valuable form of healthcare for patients managing cardiovascular disease (CVD). However, there some challenges when using it in rural areas and poor communities. This according to a scientific statement released by the American Heart Association (AHA), which it published in the scientific journal Circulation. The AHA’s scientific statement, which provides an overview of telehealth in the management of CVD, is based on expert analysis of scientific research and is intended to be used to inform treatment guidelines going forward.

Telehealth provides remote health care using digital technologies such as telephonic or video consulting software and apps, as well as remote monitoring via devices that can be worn by the patient or implanted in their body. During the beginning of the COVID-19 pandemic, there was a surge in online health care visits, with telehealth visits making up 30 percent of all clinic visits in the US in 2020. However, according to the American Heart Association, telehealth visits have gradually declined after COVID-19 restrictions were relaxed towards the end of 2021.

“Telehealth is transforming the way health care is delivered by improving convenience and availability,” 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 Rochester, Minnesota. “However, we learned during the pandemic when we were forced to limit in-person care that there are limitations to using telehealth.”

The AHA’s new scientific statement highlights the benefits of telehealth in managing heart disease, peripheral artery disease, and stroke. It provides a review of strategies and challenges for adopting telehealth to help manage cardiovascular disease, while also identifying knowledge gaps.

The Benefits of Telehealth for the Management of CVD

After reviewing current research, the author’s found that telehealth offers three significant benefits, including reducing the cost of healthcare; improving access to healthcare services in rural areas and underserved communities; and increasing patient satisfaction with the quality of the health care they receive. These benefits are particularly important for patients with CVD, which statistically disproportionately affects people from minority ethnic, racial, and other groups who typically lack the means to access conventional health care services or who have a strained historical relationship with the medical community.

Online telehealth services and smart devices offer cost-effective solutions for remotely managing health conditions such as high blood pressure, coronary artery disease, and heart failure that are considered high risk factors for cardiac disease. “Telestroke,” for example, an area of cardiovascular disease that has been intensively studied, allows first responders to provide highly specialized stroke care to stroke patients under the guidance and instruction of stroke experts located remotely. Telestroke services provide patients with a better chance of rehabilitation and recovery, especially when they lack access to specialized stroke treatment and care.

The Challenges of Telehealth for the Management of CVD

Challenges that can limit the use of telehealth in the management of CVD include barriers faced by both patients and health care providers. Acceptance and adoption of telehealth technologies varies due to the age of the both provider and patient, their technological savvy, and their perceptions of telehealth.

Additionally, there have been inconsistent policies regarding reimbursement and licensing requirements (which can vary from state to state). Logistical problems with scheduling appointments and maintaining a steady workflow are also a hindrance. Finally, providers are currently unable to analyze data received from devices monitored remotely due to lack of equipment.

Privacy and security issues are other important considerations for healthcare professionals. Although many telehealth platforms are protected to some degree by encryption, they are not 100 percent secure. The risk of data breaches always exists, Takahashi explained. The challenges identified for patients with cardiovascular disease include:

Access: Some patients — particularly elderly patients and those from less resourced communities — do not have access to appropriate technologies and smart devices.

Communication: Cultural barriers limit access to digital telehealth platforms, wearable medical devices, and other digital devices. This prevents them from being used to their full potential.

Limited Internet Access: Insufficient internet bandwidth cannot support good quality video transmission needed for telehealth appointments.

Strategies to Overcome These Challenges

Infrastructure, digital technologies, and reimbursement for telehealth consultations are the primary stumbling blocks to telehealth use that need to be addressed. Approximately 25 percent of adults living in the US do not have access to broadband internet. The American Heart Association suggests that broadband internet access needs to be expanded, especially to rural communities that do not have access to health care facilities and are essentially a “medical desert.” The American Heart Association suggests that public policy changes that support efforts by the private sector to make internet services more affordable and more accessible would be helpful.

Telehealth can potentially play a bigger role in providing urgent medical diagnosis and monitoring of medical conditions remotely, said Takahashi. However, agreement regarding reimbursement for the delivery of telehealth services needs to be reached. Reimbursement for in-person, telephonic, and video visits are not always reimbursed equally by all medical insurance companies. As a result, medical practitioners who provide remote healthcare to patients without a video component ultimately receive lower reimbursements for those services compared to in-person or video appointments.

“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.”