Telecardiology: The Future of Cardiology Care
Access to Cardiology Care
As chief medical officer at Heartbeat Health, a virtual-first cardiology practice, Dr. Jana Goldberg is at the intersection of telehealth and cardiology care. She has several concerns when it comes to telemedicine and cardiac care. She’s worried about access, because the supply-demand mismatch in cardiology is critical. She wants to improve outcomes, because she believes virtual care enables rapid titration of guideline-directed therapy. She’s focused on resource optimization, because cardiologists can stratify patients by need with telemedicine. And she’s interested in the role of hybrid models because virtual care will never replace in-person procedures or acute interventions.
Overcoming Access Challenges
Q: 46% of U.S. counties lack a local cardiologist and urban wait times exceed 30 days. How can telecardiology help overcome these access challenges?
A: That’s right. Almost half of the U.S. counties, impacting 22 million residents, have no cardiologist located in their area. These tend to be areas that are rural and socioeconomically disadvantaged.
Patients living in those areas already have a high risk of heart disease due to underlying risk factors and, astoundingly, a one-year shorter life expectancy than those with cardiologists. The problem extends into urban settings where some appointment times exceed 30 days depending on the city and continue to go up.
Further, a quarter of cardiologists intend to leave over the coming years. With a population getting sicker, we are facing a critical supply/demand mismatch.
Given both the current and projected outlook, telecardiology will serve an essential function in the coming decades. Here, I define telecardiology more broadly than just connecting cardiologists and patients via tele-visits. Rather, it is the larger implementation of remote-first diagnosis and treatment for patients with cardiovascular conditions.
Improving Outcomes
Q: How can telecardiology reduce hospitalizations and mortality rates?
A: There have been numerous clinical trials challenging the impact of telecardiology on various endpoints of interest, including blood pressure and cholesterol control, hospitalization, mortality, quality of life, among others.
Though some of the trials have had mixed data, they have also employed different models to effectuate impact. Overall, the literature supports that it can play a significant impact in improving outcomes.
A recent meta-analysis synthesizing evidence from 29 randomized trials and involving nearly 14,000 adults with heart failure illustrated that telecardiology significantly reduced hospitalization by 6% and mortality by 10%. Leveraging telecardiology not only reduces readmission, it improves health literacy and quality of life.
Resource Optimization
Q: What can telecardiology do to reduce unnecessary visits while ensuring high-quality care?
A: I would break down the impact into a couple different areas: routine like ambulatory care visits and high acuity like ER visits.
Given the breadth of disease, we need better ways to manage the influx of patients into the specialty outpatient, or ambulatory care setting. The right way to think about using telecardiology in this setting is using innovative care pathways to meet the level of patient need.
In this setting, we need to lean into a primary care-first model but maintain adequate support from specialists. For many questions, an e-consult pathway can provide primary care physicians with what is needed to manage a patient themselves.
Hybrid Models
Q: The hybrid model in telemedicine seems to be the wave of the future. What happens when you blend telecardiology and brick-and-mortar care?
A: I see this hybridization occur in three key areas: primary care, home care, and other specialty practices.
For several years, in primary care practices – particularly at-risk organizations or ACOs – telecardiology became a natural adjunct to their broader cardiovascular strategy. The objective has been clear: control healthcare costs while delivering high-quality care.
Next, healthcare is increasingly shifting into the home. Meeting patients where they are is essential, especially for those who face barriers to traditional in-person care. With clinicians delivering diagnoses and management in-home, this approach supports both routine and high-risk care.
Conclusion
Dr. Goldberg’s concerns about access, outcomes, resource optimization, and hybrid models demonstrate the critical role that telecardiology will play in the future of cardiology care. By leveraging telecardiology, cardiologists can overcome access challenges, improve outcomes, and optimize resources. The hybrid model, which blends telecardiology and brick-and-mortar care, will be essential in delivering high-quality care to patients.
FAQs
Q: How can telecardiology overcome the supply-demand mismatch in cardiology?
A: Telecardiology can connect patients with cardiologists in areas where there is a shortage of cardiologists, improving access to care.
Q: Can telecardiology replace in-person procedures or acute interventions?
A: No, telecardiology will never replace in-person procedures or acute interventions, but it can support and optimize care.
Q: What are the benefits of telecardiology in improving outcomes?
A: Telecardiology can improve outcomes by enabling rapid titration of guideline-directed therapy, reducing hospitalization and mortality rates, and improving health literacy and quality of life.
Q: What is the role of hybrid models in telecardiology?
A: Hybrid models blend telecardiology and brick-and-mortar care, supporting primary care, home care, and other specialty practices to deliver high-quality care.
