Impact of Telehealth on Failure to Attend Rates and Patient Re-Engagement in Adult Congenital Heart Disease Clinic

Melissa G Y Lee; Jeremy J Russo; Juliet Ward; William M Wilson; Leeanne E Grigg

doi:10.1016/j.hlc.2023.08.010

Impact of Telehealth on Failure to Attend Rates and Patient Re-Engagement in Adult Congenital Heart Disease Clinic

Heart Lung Circ. 2023 Nov;32(11):1354-1360. doi: 10.1016/j.hlc.2023.08.010. Epub 2023 Oct 10.

Authors

Melissa G Y Lee¹, Jeremy J Russo², Juliet Ward², William M Wilson³, Leeanne E Grigg³

Affiliations

¹ Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia; Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia. Electronic address: melissa.lee1@unimelb.edu.au.
² Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia.
³ Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia.

PMID: 37821262
DOI: 10.1016/j.hlc.2023.08.010

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic paved the way for telehealth consultations. We aimed to determine the impact of telehealth on rates of failure to attend (FTA) in adult congenital heart disease (ACHD) clinics and whether telehealth could re-engage patients with previous FTA face-to-face appointments.

Methods: This was a retrospective audit of a tertiary ACHD clinic over a 12-month pre-telehealth (26 March 2019-17 March 2020) and 12-month post-telehealth implementation period (24 March 2020-16 March 2021). Patients with one or more FTAs during the 24-month study period were included. Our ACHD clinic is run three times per month. Patients with ACHD are offered lifelong follow-up and reviewed annually on average. Re-engagement was defined as two or more consecutive face-to-face FTAs immediately before the telehealth period with subsequent attendance of their telehealth appointment.

Results: A total of 359 patients with a total of 623 FTAs were included. Complexity of congenital heart disease was moderate in 56% (202/359) and severe in 19% (69/359) of patients. Overall FTA rate was 18% (623/3,452). FTA rate was significantly lower in the post-telehealth period (15%, 257/1,664) compared with the pre-telehealth period (20%, 366/1,788) (p<0.00001). At study conclusion, 1% of patients had died (5/359). Of the 354 remaining patients, 42% (150/354) were considered lost to follow-up (two or more FTAs including telehealth), 37% (132/354) missed only one clinic appointment, and 20% (72/354) previously considered lost to follow-up had re-engaged in the telehealth period.

Conclusions: Rates of FTA in a tertiary ACHD clinic significantly reduced after the introduction of telehealth consultation. A fifth of patients considered lost to follow-up were re-engaged with telehealth. Additional strategies to further reduce FTA should be explored.

Keywords: Adult congenital heart disease; Clinic; Failure to attend; Outcomes; Telehealth.

MeSH terms

Adult
Ambulatory Care Facilities
COVID-19* / epidemiology
COVID-19* / therapy
Heart Defects, Congenital* / epidemiology
Heart Defects, Congenital* / therapy
Humans
Retrospective Studies
Telemedicine*