DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study

Abstract

Background: Telemedicine requires either the use of digital tools or a minimum technological knowledge of the patients. Digital health literacy may influence the use of telemedicine in most patients, particularly those with frailty. We aimed to explore the association between frailty, the use of digital tools, and patients’ digital health literacy. Methods: We prospectively enrolled patients referred to arrhythmia outpatient clinics of our cardiology department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into robust, pre-frail, and frail. The degree of digital health literacy was assessed through the Digital Health Literacy Instrument (DHLI), which explores seven digital skill categories measured by 21 self-report questions. Results: A total of 300 patients were enrolled (36.3% females, median age 75 (66–84)) and stratified according to frailty status as robust (EFS ≤ 5; 70.7%), pre-frail (EFS 6–7; 15.7%), and frail (EFS ≥ 8; 13.7%). Frail and pre-frail patients used digital tools less frequently and accessed the Internet less frequently compared to robust patients. In the logistic regression analysis, frail patients were significantly associated with the non-use of the Internet (adjusted odds ratio 2.58, 95% CI 1.92–5.61) compared to robust and pre-frail patients. Digital health literacy decreased as the level of frailty increased in all the digital domains examined. Conclusions: Frail patients are characterized by lower use of digital tools compared to robust patients, even though these patients would benefit the most from telemedicine. Digital skills were strongly influenced by frailty.

Cardiology in a Digital Age: Opportunities and Challenges for e-Health: A Literature Review

“…Additionally, advanced age and a low level of education in patients are often identified as potential obstacles to the widespread use of such solutions [ 25 ], as well as a source of anxiety and alienation [ 38 ] feelings that are exacerbated by the inherent impersonality of digital services [ 34 ]. In specific settings, such as heart failure, atrial fibrillation, and stroke, characterized by advanced age [ 51 , 52 , 53 ], frequently associated with frailty and disability [ 43 ], regarding the lack of digital literacy [ 54 ], the involvement of caregivers and family members may be an option to be considered.…”

COVID-19 pandemic and trends in clinical outcomes and medication use for patients with established atrial fibrillation: A nationwide analysis of claims data

“…Second, the unavailability of resources in health systems overwhelmed with COVID-19 cases may have resulted in lower likelihood of hospitalization. Patients manifesting with milder symptoms may have been managed in the outpatient setting, owing to the rapid increase in the availability and utilization of virtual visits [ 21 ]. Additionally, it has been reported that the COVID-19 pandemic caused interruptions in services, including diagnostic testing, which may have contributed to decreased diagnosis [ 22 , 23 ].…”